Carolina Pediatric Therapy accepts referrals from Parents, Doctors, Children’s Developmental Services, Health Departments, and other agencies serving children in Western North Carolina. Find out what information we need from you to get started.
To Get Started with Therapy Services, please call our office at 828.398.0043. Our office manager will get some basic information from you during this phone call. We will also need:

  1. A prescription order of referral from your child’s primary physician. You may get this yourself, or we can request it from your child’s physician.
  2. A copy of your primary Insurance card and/or your child’s Medicaid card. If your child is covered under your insurance AND has Medicaid, please send both cards. Medicaid requires that we bill the primary insurance first before they will pay for services.
  3. The buttons below are our Patient forms you will need to fill out and sign.
  4. Once you have filled out the forms and we receive your forms. One schedulers will reach out to you to schedule an appointment with one of our therapists. 
carolina pediatric therapy
Parent Manual & Signature Forms


Patient Intake Forms
Medical History Forms
Guidance for Calling Your Insurance Company

About Insurance

We ask that you realize that we do not work for an insurance company. Rather we work 100% for our patients. We feel that insurance can be a great benefit for many patients and want you to know we will do everything in our power to ensure you get every benefit allotted in your insurance contract. However, the treatment we recommend and the fees we charge will always be based on your individual needs, not your insurance coverage.

Insurance Information

We will file with any Commercial Insurance Carrier. Please remember to check with your carrier to confirm we are in network or if a pre-certification is required to begin services. We encourage parents to call their insurance carrier for specific benefits and policy information. It is your responsibility to know and understand your insurance benefits and coverage. Please make sure that the service your child requires is covered by your insurance policy prior to service. If a service is not covered, you will be responsible for the cost of service.