Contact Us | Pediatric Speech Language Therapy In Texas| Empower Therapy

Email [email protected]
Scheduling contact (512)-401-3612
Client Contact (512)-661-4387
FAX (512)-717-5553

Contact our Support Office

Name

Date

Name of Parent

Relationship to Client*

Phone

Email

Street Address

City,State,Zip

Diagnosis for Autism Spectrum Disorders?

Primary Health Insurance Company*

Insurance Member ID(for verification of benefits)"

Group ID

Name of Pediatrician

Employer (associated with primary health insurance)

Insurance Phone Number (on card)

Preferred Appointment Date and Time

Types of Therapy

ABA

Speech

OT