Therapy Interest Form

Therapy Interest Form

Indie Learning Co. is an independent learning company that believes in nurturing the whole child in an immensely supportive learning environment. Our naturalistic approach to therapy ensures that sessions are person-centered, child-led and respectful of communication and sensory needs. Fill out the below fields to the best of your ability and a member of our team will reach out with next steps!
Parent/Caregiver Information
Parent/Caregiver Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Child's Information
Child's Name*

First NameLast Name
Child's Age:*
At this time, due to our approach, Naturalistic Behavioral Therapy will not be covered by insurance. We will continue to bill under ESA, HSA and FSA for this program.
I am interested in:*

In-center Naturalistic Behavioral Therapy (ESA/Private Pay Only)In-center Speech-Language TherapyIn-center Occupational TherapyIn-center Physical Therapy
For each therapy you indicated interest in, please list any areas of concern you’d like the therapist to review.*
Should be Empty:

Parent/Caregiver Information