EBS Early Intervention Photos
Getting Started:

Thank you for your interest in EBS Early Intervention!  Prior to starting, we will need the following information to begin this process.

Check List:

  • Insurance Information
  • Prescription from your child’s primary care physician with ICD-9 code and frequency of service

Patient Form:
Parent's Name
Child's Name
Address
City, State, Zip
Phone Number
Cell Phone
Email
Diagnosis
Type of Service
Other Concerns
Insurance
HMO / Other
Comments
 
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