Ready to Get Started?

Brighton Center’s Pediatric Therapy Clinic provides speech, occupational, and physical therapy for children ages 3–6. Our licensed therapists work with your family to support your child’s communication, movement, and daily skills during these important early years. Completing this form is the first step toward personalized care for your child.

Please Note: A referral from your child's pediatrician is required before an evaluation can be scheduled and completed.

Here's what to expect:

✔ A member of our team will reach out within 2 business days

✔ We will review our services, discus your child's needs and your insurance information.

Let's start your child's progress today!

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Do you currently receive services from any of the following Brighton Center Programs (check all that apply)

Early Childhood Intervention (ECI) Program

Special Education Support Services

Brighton Preschool Program

Pediatric Therapy Clinic

None, we currently do not receive services from Brighton Center

Child First Name *

Child Last Name *

Child Date of Birth *

Child Gender *

Guardian First Name *

Guardian Last Name *

Guardian Phone *

Guardian Email *

Address *

City *

State *

Postal code *

How did you hear about Brighton Center's Pediatric Therapy *

Reason for Referral *

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