Theraplay, LLC  
Providing pediatric speech, occupational and developmental therapy in Lee, Harnett, Moore & surrounding counties in N.C.
135 Chatham Street, Sanford, NC 27330 | Phone 919-774-1281 | Fax 919-774-1282 
Send us an email at info@theraplaync.com

Let us help you help your child blossom!

Resources and Forms

For your convenience we have provided you the opportunity to download our new patient packet. Bring these with you to your first appointment and be ready to go to avoid any further wait time at your session. For Medicaid patients, please download this additional policy letter. We look forward to working with your children!

Online Referrals

Theraplay is currently accepting referrals and we are pleased to now offer the ability to make referrals online.  Please fill out the referral form for pediatric speech therapy services.  Please complete the form as fully as possible.

Date:
Client's name: (required) *
Client's DOB: (required) *:
Parent/Guardian: (required) *:
Street Address: (required) *:
City: (required) *:
Zip Code:
Home phone: (required) *:
Cell phone: :
email address::
Primary Care Practice::
Primary Care Provider::
Referral Source::
Reason for Referral::
Insurance Company::
Additional Insurance::
Policy Number::
Group Number: :
Policy Holder's Name: :
Policy Holder DOB: :
Authorization No. (Tricare only):
Notes::
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