New Patient Referral Form

Thank you for your interest in receiving therapy at Therapy Works, PC.

Kindly complete the following form so we can begin the process of providing therapy for your child. This will ensure that we have the correct information so we can check for insurance eligibility.

It will take about 10 minutes to complete this form. Please have your doctor's name and contact information as well as your insurance card ready.

You do not have to print this . It will automatically notify our front desk once completed and we will give you a call.

If you have any questions, kindly call 770-995-2379 or email office@therapyworkspc.com .

Thank you and we look forward to working with you and your child.