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TeleHealth and Virtual Service Inquiry Form

Fill Out the TeleHealth Inquiry Form

TeleHealth and Virtual Services Inquiry Form

Completing this form will alert our staff that you would like to speak with a therapist. One of our office staff will be in contact to set up a time to speak with a therapist on the phone. Completing this form will help our therapists prepare for their phone call with you.

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  • Emerge Pediatric Therapy is an in-network provider for all Tricare insurance plans, Health Choice, and NC Medicaid. We reserve a limited number of slots for children under these programs. We will bill these plans directly and collect any co-payments and deductibles as necessary. We are out-of-network for private commercial insurance plans. Please visit our FAQ page on our website to learn more: https://www.emergepediatrictherapy.com/about-us/faq/
  • Appointment times will vary depending on services selected. Most appointments range between 30 minutes and 2 hours.