Request Services

Please submit a request for services. After review, a team member will contact you about the best fit for your child.

Child's Name

First Name

Last Name

Child's Date of Birth

MM

DD

YYYY

Parent/Guardian Name

First Name

Last Name

Parent/Guardian Phone Number

(###)

###

####

Type of Therapy Service

Service Location

Message

Share any details or questions—we’re here to support you.

Patient Records

Begin the Intake Process at Operation Breakthrough
Fill out the patient intake form.

Existing patient?
Access to the Patient Portal here.

Phone: (913) 890-3778

Fax: (913) 392-3482

Address: 12351 W 96th Terrace Suite 203, Lenexa, KS 66215