
Patient Intake Form
Ready to start your child’s journey? Please complete the below form for your desired clinic location with as much information as possible. An intake counselor will then be in contact with you.




Southlake Location
Southlake Intake Form ↗
Fort Worth Location
Fort Worth Intake Form ↗
Flower Mound Location
Flower Mound Intake Form ↗
Colleyville Location
Colleyville Intake Form ↗IMPORTANT: please click “Submit Form” ONCE only.
Why Choose PediaPlex?
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Everything You Need, All Under One Roof
No more juggling multiple clinics. PediaPlex offers ABA therapy, speech therapy, occupational therapy, and more—all in one place. Plus, with five convenient locations across Texas, help is always close by.
Dedicated to Long-Term Growth
Our staff are employees, not contractors. This means you’ll have a consistent team committed to your child’s progress for the long term, fostering stability and trust.
Personalized Care You Can Trust
Every child is unique, and so is our approach. At PediaPlex, we tailor treatments to your child’s specific needs, providing compassionate, individualized care that makes a difference.
Accepted Insurances*









*Please note that insurance coverage may vary depending on the type of service provided and the terms of individual insurance policies. Kindly note that we do not accept Medicare or Tricare.
Explore Our Services


Take the First Step Toward Your Child’s Success
Discover how PediaPlex’s expert care can support your child’s growth and development. Fill out the Patient Intake Form or contact us today to schedule an evaluation and start your journey toward success!
Patient Intake Form ↗ or Contact Us
Accepted Insurances*









*Please note that insurance coverage may vary depending on the type of service provided and the terms of individual insurance policies. Kindly note that we do not accept Medicare or Tricare.







