Contact

We can’t wait to see your child Blossom! Reach out with any questions!

Intake and Scheduling: scheduling@blossomptp.com

General Inquiries: hayley@blossomptp.com

Please note, we are in-network providers for Anthem Blue Cross Blue Shield commercial plans only. We also accept Autism and Jon Peterson scholarships. If your insurance is out-of-network, we can provide a superbill to help you seek potential reimbursement from your insurance provider.

Contact us today to schedule!

First Name

Last Name

Phone

Patient Name and Date of Birth

Service Location Address (Provide a specific address or town when possible - home, school, daycare, etc.)

Funding Source (Private Pay, ODE Scholarship, etc.)

Service(s) Requested: * Required

Occupational Therapy

Speech Therapy

Physical Therapy

Does your child have a current OR recent:

Evaluation Team Report (ETR)

Individualized Education Plan (IEP)

Psychological Evaluation

504 Plan/Accommodations Plan

Preferred contact method:

Call

Text

Do you have specific days/times that you prefer to receive therapy services to occur? If yes, please let us know:

Please tell us your preferred language for written and verbal communications:

Briefly describe your primary concern(s) for your child:

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