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Fill Out the Initial Inquiry Form

Initial Inquiry Form

Completing this form will alert our staff that you would like to speak with a therapist. One of our office staff will be in contact to set up a time to speak with a therapist on the phone. Completing this form will help our therapists prepare for their phone call with you.
  • Date Format: MM slash DD slash YYYY
  • Emerge Pediatric Therapy is an in-network provider for all Tricare insurance plans, Health Choice, and NC Medicaid. We reserve a limited number of slots for children under these programs. We will bill these plans directly and collect any co-payments and deductibles as necessary. We are out-of-network for private commercial insurance plans. Please visit our FAQ page on our website to learn more: https://www.emergepediatrictherapy.com/about-us/faq/