Get Adobe Reader

Self Pay

Kirsch Therapy offers competitive pricing and discounted rates for time-of service payments. We offer a variety of programs to meet your family's needs. Please contact us to inquire about current evaluation and therapy rates.

Insurance Information

We accept:

The New Patient Packet includes these forms:

  • Consent to Treat
  • Evaluation Questionnaire - Child
  • HIPAA Medical Release
  • Patient Information
  • Release of Information
  • Credit Card Authorization

New Patient Information

Please print these forms, fill them out, and bring them with you to your office visit.