In the state of Pennsylvania, a physician referral is required for your child to receive Physical Therapy services. If your child has been determined to be eligible for school based physical therapy services, you can access the Physician Referral Form on-line. Please have your child’s doctor fill the form out so your child can begin school based physical therapy. Your child is not able to receive physical therapy services until the form is returned. The form may be scanned via email, mailed, or faxed.

Parent Letter - Instructions For Submitting PT Prescriptions 

Physician Referral Form 20-21