Occupational Therapist

Request an evaluation with Kayla

Tell us a little about your family and a few times that work — we'll confirm within one business day.

Your information

Your name*

Phone*

Email*

I agree to the terms and privacy policy.

I consent to receive text messages from Origin Therapy at the phone number I provided about intake, scheduling, appointment reminders, provider matching, insurance/eligibility follow-up, and care coordination. Message and data rates may apply. Message frequency may vary. Reply STOP to opt out and HELP for help. Consent is not required to receive care from Origin Therapy. See our Terms of Use and Privacy Policy.

What brings you here?*

What does your child need help with? Pick at least one.

Please describe in more detail*

Where would you like therapy?*

Select any that apply — we'll ask for each address.

Where you live*

We ask every family for this, including video and office visits, so we can match your child with a provider licensed to serve their home state. It isn’t used as a session location.

Home address

Street address*

City*

State*

ZIP*

When are you generally free?*

Click or drag to select time windows. Pick at least one — this isn't your appointment time; we'll follow up to lock in the exact day and time.

Mon

Tue

Wed

Thu

Fri

Sat

Sun

Morning8–12

Afternoon12–3

After School3–5

Evening5–8

Payment*

How would you like to handle payment?

Your child

We use this to verify benefits under your child's name and start their file.

Child's first name*

Needed to check your insurance under their name.

Child's last name*

Date of birth*

We never share your information.