Initiating Service Forms
Does Your Child Need Us?
Phone: 479-474-6444 . Fax: 479-474-6446 . insynctherapy@gmail.com
Copyright © In-Sync Pediatric Therapy Center . 1202B Main St. . Van Buren, AR 72956
Initiating Services
“I believe in the potential of every child to grow, develop, and contribute.”
– Jocelyn Mitchelle, M.S.,OTR/L, Owner
In-Sync Pediatric Therapy will accept referrals from Physicians, parents, Children’s Developmental Services, Health Departments, and other agencies serving children.
For Evaluations and/or Therapy Services, please call our office at 479-474-6444. Our Office Administrators will get some basic information from you regarding your child during this phone call.
We will also need:
1. A prescription/referral from your child’s primary physician. Our office will contact your child’s physician and request this directly.
2. A copy of your primary Insurance card and/or your child’s Medicaid card. If your child is covered under a commercial insurance policy AND has Medicaid, please bring both cards. Medicaid requires that we bill the primary insurance first before they can be billed for services.
3. Completed and signed New Patient Forms. Please see the New Patient Checklist below for further information.
Once all of the appropriate information is received, a therapist will then call you to personally set up your child’s first appointment. In-Sync Pediatric Therapy will bill your insurance for you. We accept Arkansas Medicaid, SoonerCare, and all Private Insurances.
If you have any questions or concerns at any time please contact us and we will assist you in any way possible. We look forward to serving your child and family!