Sign Up for Our Programs

IMPORTANT: To sign up for Playgroups / Classes, Preschool program and Pediatric Therapy Services including Developmental Therapy, Behavioral Therapy, Music Therapy, Art Therapy, Speech Therapy and Family Counseling, please call us first at 312-458-9865 for more information and pricing. When you're ready to sign up online, choose the service from the drop down menu and enter the price in the next screen.

To sign up for other services, simply choose your item from the menu below, fill in the form and click the PROCEED TO PAYMENT button. It will direct you to Paypal for payment. Please note that you do not need a Paypal account. Paypal also accepts major credit cards. For more information, please click on the Paypal logo above.

EB Pediatric Resources requires that each family fill out a release of liability form. Please also note the Playgroup Rules. These rules must be followed for the safety of the children.

Billing Policy

Our fees are based on professional and community standards. We ask that patients pay for professional services and supplies at the time services are rendered. Financial responsibility for services lies with the patient; however you may request a HCFA form which you can then submit directly to your insurance company for possible reimbursement.

If you have any questions about our fees or payment policy, or prefer to sign up over the phone, please contact us at 312-458-9865 or pediatricresources@sbcglobal.net

Select Program:	Playgroups / Classes: Speech and Socialization Playgroups * Speech & Language Camp * Art & Creativity Camp * Dyads * Home-based Pediatric Services: Global Developmental Evaluation - $375 Infant Massage Instruction (Individual) $135 Infant Massage Instruction (Group of 3 minimum) - $55/person Child Needs Assessment / Consultations - $120 Therapeutic Play Interactions including assessment - $345 Therapeutic Play Interactions renewal - $210 Preschool Program * Pediatric Therapy Services: Developmental Therapy * Behavioral Therapy * Music Therapy * Art Therapy * Speech Therapy * Family Counseling * Miscellaneous (enter your own amount) For items marked with * call 312-458-9865 for pricing
Parent's Name:
Child's Name:
Telephone:	(e.g. 123-456-7890)
Email:
IMPORTANT: If you're signing up for Playgroup or Class, please type in your choice of session and day of week (e.g. Spring session/Friday) in the "Additional Information" box below. If unsure, type "contact me". If you're signing up for other services, please enter the service name in the "Additional Information" box below.
Additional information
I have read the waiver and fully understand that it is a release of liabililty. I understand that by signing up through this web site, I agree all the policies of EB Pediatric Resources as stated in the waiver.