Children's Therapy Connection

Quality, comprehensive and family-centered pediatric therapy services.

Home
Why CTC?
- Close
- - About Us
    - Close
    - Children’s Therapy Connection (CTC) is a family-owned First Steps agency and pediatric therapy provider serving central Indiana families since 2007. We focus on the concerns and goals expressed by your family, seeking to provide innovative and constructive therapy interventions that are age-appropriate and tailored to your child’s needs. Read more
  - First Steps Services
    - Close
    - Children’s Therapy Connection (CTC) is a family-owned First Steps agency and pediatric therapy provider serving central Indiana families since 2007. We focus on the concerns and goals expressed by your family, seeking to provide innovative and constructive therapy interventions that are age-appropriate and tailored to your child’s needs. Read more
  - Pediatric Therapy Services
  - Pediatric Therapy Programs
Our Team
- Close
Parent Resources
- Close
Blog, News & Events
Careers
Contact Us

You are here: Home / Refer My Child

Refer My Child

Referral Intake Form

If you are a human and are seeing this field, please leave it blank.

Fields marked with a * are required

Child's Name *

Child's Date of Birth * Help Text

Help Text

Parent/Guardian Name

Relationship to Patient

Phone Number *

Email Address *

Street Address

City

State

Zip / Post Code

Service/Evaluation Requested *

First Steps
Speech/Language Therapy
Physical Therapy
Occupational Therapy
Feeding Therapy (Group/Individual)
LEGO Skill Builders
Therapeutic Yoga
Speech Playgroup
Social Skills Playgroup
Gross Motor Playgroup
It Takes Two to Talk Hanen Program
Social Work
LEGO Spring Break Camp
Yoga Spring Break Camp

Have a therapy prescription? *

Yes
No

Primary Insurance *

Anthem
Blue Cross/Blue Shield
Cigna
Aetna
Sagamore
UnitedHealthcare
Medicaid/Hoosier Healthwise/MDWise
Other

Insurance Provider Services Phone Number Help Text

Help Text

Insured's Name *

Member ID Number * Help Text

Help Text

Referring Physician Name

Physician Practice Location

Scheduling Preferences

How did you hear about us?

Notes

If you are a human and are seeing this field, please leave it blank.

Parent Resources

Refer My Child
Patient Forms
Private Insurance Providers
Patient Policies
Videos for Families
Helpful Links
Blog, News & Events
Testimonials

Blog Topics

Blog Topics

Blog, News & Events

We’re Moving!

January 28, 2021 By Jason Berty

When? Monday, February 1, 2021. All appointments on or after … » view this article

Why should we care about crawling?

October 19, 2018 By Michaela Bortle

Written by Michaela Bortle, PT, DPT “Oh my son never crawled, … » view this article

Why Yoga for Kids?

October 2, 2018 By Jazmin Rambeau

We are excited to offer two weekly kids yoga classes at … » view this article

Connect With Us

Children's Therapy Connection
7478 Shadeland Station Way
Indianapolis, IN 46256
Map It
Phone (317) 288-7606
Fax (317) 288-7607
E-Mail Us

Blog, News & Events

CTC New Location

We’re Moving!

January 28, 2021

When? Monday, February 1, 2021. All appointments on or after 2/1 will be … + read more

Why should we care about crawling?

October 19, 2018

Written by Michaela Bortle, PT, DPT “Oh my son never crawled, he just … + read more

Why Yoga for Kids?

October 2, 2018

We are excited to offer two weekly kids yoga classes at Children’s Therapy … + read more

Join Our Mailing List

* indicates required

Email Address *

First Name

Last Name

[footer_backtotop]

Copyright © 2021 Children's Therapy Connection, Inc. · Design by Bloom Design Studios · Log in

Insert/edit link

Enter the destination URL

URL

Link Text

Open link in a new tab

Or link to existing content

Search

No search term specified. Showing recent items. Search or use up and down arrow keys to select an item.