New Clients

Let’s find your child’s next step.

Thank you for your interest in Midsouth Therapy Group! Tell us a little about your child below — it's the first step toward getting started.

ABA therapy: we’re accepting a limited number of preschool-aged children for ABA in select area preschools. We’re not currently offering ABA in our clinic or accepting school-aged children for ABA in any setting — tell us about your child and we’ll follow up about the right options.

It takes about 5 minutes. Fields marked * are required, and everything you share stays confidential.

Step 1 of 6

About you

Step 1 of 6

Who’s completing this form

Your name

Relationship to child

Child's guardian's name

Phone

Use an address you check often — we communicate primarily by email.

We use this information only to evaluate and coordinate your child’s care. Your information is kept confidential.

Let’s find your child’s next step.

Who’s completing this form

About your child

Doctor & referral

Services & history

Insurance

Finishing up