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Therapy Referral Form

To obtain therapy services please email this form to info@collaborative-change.com or fax to (317) 203-0955. Once we verify eligibility we will contact you to begin services. If you have any additional questions or concerns feel free to contact us via email here or call (317) 296-4187. We accept Medicaid, Hoosier Healthwise, HIP, HIP 2.0, Medicare, most private insurances and self-pay.

Parent Cafe Information Reqest

If you are interested in Parent Cafes or having us come to host or consult with your organization on building a cafe program please contact our Parent Cafe Director Brettany Ervin. We offer everything from hosting cafes to training staff within an organization on building a program or offering consultation on marketing, programming and developing cafes programs within the community.

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