The Grove Pediatric Therapy

The Grove Pediatric Therapy Send Message

Who would be receiving care?

Someone else

Your info

First name

Last name

Phone

Date of birth

Gender

Home address, city, zip

Name of school or daycare (type N/A if not in school or daycare)

Reason for care

Please tell us about your primary concerns for your child and what you would like help with.

Limited to 600 characters

Which service(s) are you interested in for your child?

Occupational therapy Physical therapy Speech therapy Developmental screener Unsure

Administrative

How can The Grove Pediatric Therapy help you today?

I would like to schedule an evaluation I am interested in a developmental screening I have questions about rates or payment options I have questions about occupational therapy I have questions about physical therapy I have questions about speech therapy Questions about treatment approaches or specialties I have feeding or oral-motor concerns I want to know whether therapy may benefit my child I have questions about FES-UA scholarship funding I am interested in community or daycare-based services

Billing & Payment

Payment method

How do you plan to pay for your child’s services?

Self-pay FES-UA scholarship I'm not sure yet

Client Preferences

Is there anything else you would like our team to know?

Please share any additional questions, preferred treatment location (home, school, Happy Campers office), scheduling needs, or information that may help us respond to your inquiry.

Limited to 600 characters

For medical emergencies, contact your healthcare provider or call 911. For mental health crises, call or text 988.

By submitting this form, you agree to the processing of your sensitive personal information, which may include protected health information (PHI). This information may be viewed by team members in this practice. You also agree not to submit any payment information, including credit or debit card details, through this form.