Refer a Patient

The CARES Therapy Clinic is a student managed and staffed non-profit organization that provides free occupational, physical, and speech therapy services to adults without health insurance.

We see clients two nights per week from 6:00 to 8:00 p.m.:

• Tuesday for Neurologic diagnoses
• Wednesday for Orthopaedic diagnoses.

Please complete the form below to refer a patient to the clinic.

Be advised: After submitting the form, on the next page you will be asked for your e-signature. You will receive a link in your email that you will need to click to verify your signature. When this link is either clicked or pasted into your browser, it will open up to a page that says "Sorry, there seems to be a problem. Cannot verify signature for a completed e-signature record." Ignore this. You will receive a confirmation email that your signature has been verified.

Request for Occupational, Physical or Speech Therapy Letter of Medical Necessity