New Patient Forms
Thank you for choosing TheraFUNction! If you are interested in having your child seen for Occupational or Speech Therapy services, please contact your primary care Physician for a referral. We are "In Network" for the following insurances: Blue Cross Blue Shield, Cigna, Soonercare and Tricare. We can see you "Out of Network" for any insurance provider and you can submit our invoice/superbill to be filed with your insurance company for reimbursement. Please contact the office for "Private Pay" rates of service.
All new clients will need to fill out the "New Client Intake", which has a link below. If you have Soonercare Insurance, you must complete all the forms listed below. Please email forms to: firstname.lastname@example.org.
Please complete this form if you would like to share information with another professional, office, or family member.
If you are a Soonercare patient transferring services, please complete this form.