Schedule a Psychological Evaluation!
Psychological Evaluations are at Marshall Pediatric Therapy- Lexington 3499 Blazer Parkway, Ste 170, Lexington, KY 40509.
Your Name
*
First Name
Last Name
Child's Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address:
*
example@example.com
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth
-
Month
-
Day
Year
Date
Please describe your child's concerns (please list any currently known)
*
Are you interested in being evaluated for other services at Marshall Pediatric Therapy? (OT, PT, Speech, Mental Health, ABA)
Yes
No
If you said yes to the options above, What services are you interested in?
Occupational Therapy
Physical Therapy
Speech Therapy
Mental Health Therapy
ABA Therapy
Name of Practice & Name of Child's Pediatrician
*
Name of Insurance Provider(s):
*
We are currently only accepting Aetna Better Health and HMCO. Private Pay options are available. Call our office to hear our private pay rates 859-327-3033
Does your child already have a referral to receive therapy?
*
YES
NO
How did you learn about our services?
*
Please Select
My Pediatrician
Website
Blog posts
Marshall Pediatric Therapy Vehicles
Marshall's Developmental Assessment
Facebook
Instagram
Google
Commercial
Advertisement
At An Event
Word of Mouth
Nicholasville Elementary School
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