Therapy Interest Form
We are pleased to announce that we will be collaborating with some providers: ABA, OT, PT, & ST to provide therapy at our location! If interested, please fill out the form to share what types of therapy you'd like to see offered at our location.
Parent's Name
*
First Name
Last Name
Parent's Email
*
example@example.com
Parent's Phone Number
*
Please enter a valid phone number.
Which therapy services are you interested in?
*
Speech Therapy (ST)
Occupational Therapy (OT)
Physical Therapy (PT)
ABA
Which therapy provider would you prefer to work with?
*
Sunny Steps Pediatrics (ST, OT & PT)
Sensory Innovation Therapies (OT & PT)
BITS (ABA)
Alpha Behavior Solutions (ABA)
No Preference
Which payor do you plan to use for services with Sunny Steps Pediatrics?
*
Please Select
Sunshine Health
Children's Medical Services (CMS)
Ambetter
Straight Medicaid & Med-waiver
Step Up for Students Scholarship
Private Pay
Which payor do you plan to use for services with Sensory Innovation Therapies?
*
Please Select
Tricare East
CDC Plus
Step Up for Students Scholarship
Private Pay
Which payor do you plan to use for services with BITS?
*
Please Select
Aetna
Blue Cross Blue Shield
Cigna
TriCare Humana Military
Step Up for Students Scholarship
Which payor do you plan to use for services with Alpha Behavior Solutions?
*
Please Select
All major insurance accepted
Medicaid (in process)
CMS (in process)
I give permission for a therapist or team member from the corresponding therapy company to contact me for more information about my child’s therapy interests.
*
Yes
Submit
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