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New Patient Form

Step 1 of 5

Please have insurance and/or Medicaid cards available at the time of the appointment.

* ALL AREAS MUST BE COMPLETED FOR BILLING PURPOSES. WE ARE UNABLE TO BILL INSURANCE/MEDICAID WITHOUT THIS INFORMATION.

IF THEY ARE NOT COMPLETED YOU WILL BE BILLED.

Emergency Contact Information

In case of an emergency where we are unable to contact you, this page will be given to emergency personnel. Please fill out all spaces and note any other comments we may need to know.

Who do we contact in case of emergency?

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Pediatric Therapy in Springdale & Rogers, AR

Springdale Address:
Jarvis Pediatric Therapy, Inc.
2070 McKenzie St Suite C
Springdale, AR 72762

Phone: 479-750-7778
Fax: 479-750-7708
Emailjarvispediatric@sbcglobal.net

Rogers Address:

Jarvis Pediatric Therapy, Inc.
5507 W Walsh Ln #102
Rogers, AR 72758

Phone: 479-367-2806
Fax: 479-367-2648
Email: jarvispediatric@sbcglobal.net

Hours:
Monday - Thursday 8:00 AM - 6:30 PM
Friday By appointment only
Saturday Closed
Sunday Closed

Inclement Weather Policy: We will post any office closings on 40/29 (on TV and online) and KNWA (online only).

* We will not always be closed when the schools are closed.