Premier Children's Therapy Center

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    • Home
    • Services/Providers
      • Occupational Therapy
      • Physical Therapy
      • Speech Therapy
    • Contact Us
    • Forms
    • Patient Portal
    • What To Expect
    • Billing FAQ
    • Job Opportunities
  • Home
  • Services/Providers
    • Occupational Therapy
    • Physical Therapy
    • Speech Therapy
  • Contact Us
  • Forms
  • Patient Portal
  • What To Expect
  • Billing FAQ
  • Job Opportunities

 

Our New Patient Intake Forms are available below for you to download and complete at your convenience.

Please return completed forms to our office in order to schedule your first visit. Save forms to your computer first before filling out. You can send via email (preferred), US Mail, or Fax.


Premier Children’s Therapy Center
1000 Holcomb Woods Parkway, Suite #422
Roswell, GA 30076
Phone:  770.641.8070  Fax: 770.641.8078

jallegra@premierctc.com


Insurances we accept:

We will process medical claims on your behalf to most commercial insurance carriers. We are in network with the following plans:

  * Blue Cross Blue Shield

  * Aetna

  * Meritain

  * Tricare - Authorized Non-Network Provider

- Therapy coverage depends on your specific plan -


We bill as out-of-network providers with Cigna. We do not bill United Healthcare and UHC affiliated plans but can provide billing codes for you to submit your own claims. We do not bill Medicaid plans. 

SAVE FORM to your computer BEFORE entering your data!

Premier Children's Therapy Intake Forms 01-22 (pdf)

Download

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