Refer a Child to Playworks

Thank you for considering Playworks for your patient. We parter with pediatricians, schools, SLPs, psychologists, counselors, and other providers to deliver in-home pediatric OT services. We value collaborative care and strive to make the referral process simple. Complete the form below, and we'll follow up with the family promptly.

Provider Information

Provider name*

Organization/Practice*

Phone*

Email*

Patient Information

Child name*

Date of Birth*

Parent/Caregiver name*

Parent phone*

Parent email*

Reason for Referral

Select all that apply*

Fine motor/gross motor skills

Sensory processing

Emotional regulation

Self-care/ADLs

Executive functioning

Developmental delay

School concerns

Other

What concerns prompted this referral?*

Is the family aware of this referral?*

Yes, they are expecting Playworks to contact them

No, please contact us first

Please upload physician orders, evaluation, progress reports, or other relevant documentation (optional)

Bringing Therapy Home

Playworks provides in-home pediatric occupational therapy and parent coaching throughout Collinsville and surrounding communities within a 20-mile service area. We are happy to travel beyond our service area when scheduling allows; additional travel costs may apply.

Collinsville
Maryville
Glen Carbon
Edwardsville
Wood River
Bethalto
Caseyville
Troy
Marine
St. Jacob
Lebanon
O'Fallon
Fairview Heights
Belleville
Swansea
Granite City

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