Self Pay

Kirsch Therapy offers competitive pricing and discounted rates for time-of service payments. We offer a variety of programs to meet your family's needs. Please contact us to inquire about current evaluation and therapy rates.

Insurance Information

We accept:

The New Patient Packet includes these forms:

• Consent to Treat
  
• Evaluation Questionnaire - Child
  
• HIPAA Medical Release
  
• Patient Information
• Release of Information​
  
• Credit Card Authorization

• Anthem Blue Cross/Blue Shield HMO & PPO
  
• Blue Cross/Blue Shield
  
• EasterSeals
  
• Kaiser
  
• San Diego Regional Center
  
• Sharp Community Medical Group
  
• TriCare/UHCMV
  
• United Healthcare PPO
  
• All PPO insurance programs
  
• Private Pay
  

New Patient Information

Please print these forms, fill them out, and bring them with you to your office visit.

• New Patient Packet:
  
  • Click here to download as Word doc  (Best for Windows)
    
  • Click here to download as a PDF file  (Best for Mac)
    
• Adult Evaluation Questionnaire
  
  • Click here to download as Word doc  (Best for Windows)
    
  • Click here to download as PDF file  (Best for Macs)