New Referrals

How Do I Get Started?

If you are interested in scheduling an evaluation for your child, call our office to get started today! Below are all our new referrals forms.

Greenville office: (252) 341-9944

New Bern office: (252) 341-9944 (EXT. 2)

Goldsboro office: (252) 814-8044

Our office staff will take all of your health insurance information and complete any authorizations or referrals that you may need. Once you have scheduled an appointment, please read over and fill out the following forms. You may email, mail or fax the completed forms prior to your child’s first visit.

Email completed forms HERE

Fax completed forms to (252) 439-0957

Mail completed forms to: 1925 Turnbury Dr., Greenville, NC 27858


© 2021 Carolina Therapy Connection | All Rights Reserved 

No content displayed on this page or site may be reproduced, distributed, or commercially exploited and is only to be used for fair purposes, as defined in the Copyright Act 1968, without the express written permission of Carolina Therapy Connection. Failure to comply is an infringement of the Copyright Act and its amendments, and may be subject to legal action. 

Consent & Information Forms

Client Information Form
Consent and Authorization to Treat
Notice of Privacy Practices
Client Rights
Sensory Gym Policies and Procedures and Consent
HIPAA Photo and Video Consent Form
Photo Release Form
Email/Text Form
Teletherapy Consent Form
COVID-19 Consent Form
Formularios de admisión en español

Physician Referrals

For physicians wanting to make a referral for Occupational, Speech, or Physical Therapy services in Greenville, Goldsboro, or New Bern, please fill out the Insurance/Referral Form to the best of your ability and fax to (252) 439-0957.

Referral Form

Trillium Referrals

For Care Coordinators wanting to make a referral for Specialized Consultative Services, please fill out the following forms and email them here.

Trillium Coordinator Checklist
Referral Form
Consent and Authorization to Treat
Notice of Privacy Practice 2018
Client Rights