INQUIRY / SERVICE REQUEST FORM

Please complete the following to request a service through PIC.

If a service provider is not immediately available, you will be placed on a waiting list for your area. You will be contacted when a service provider is available to meet your needs.

Request Form

We are hiring SLPs, OTs, and PTs for LOUISVILLE & other areas!

Click HERE to join us or contact us via EMAIL

Available in Adult Day Programs, Centers for Children, Private Schools, In-Home & At-Work, in the Community, and through Telehealth!

INQUIRY / SERVICE REQUEST FORM

✓ Client Information

✓ Case Manager / Contact Information

✓ Funding / Services

✓ Parent / Caregiver Information

✓ Availability

✓ Services of Interest

✓ Additional Information