MPTS Patient Registration Forms

Please fill out the forms below that apply to your child’s enrollment.

We accept all types of insurance along with North Carolina Medicaid and Medicaid Managed Care.  We also offer options for those without coverage.  We are in-network with the following private insurers: First Carolina Care, BCBS, Tricare, Medcost, United Healthcare and Cigna

Please make sure you have spoken to someone in our office before filling out forms. If you have any questions call us at (910) 673-5437

Therapy Referral Form

Please fill out this form to get a referral from your doctor.

Patient Registration Form

Please fill this form out if you are new patient of MPTS.

Speech Language History

Fill this form out if your child is enrolling in Speech and Language Therapy.

Pediatric History

Fill out this form to give us your child's pediatric history.

Frequently asked questions

For your convenience, here are some frequently asked questions from parents and our answers. If you have any other questions or concerns please feel free to contact us.

Yes. Your information is encrypted and is for office use only. Your information will never be shared with outside parties. Please read our privacy policy.

Please fill out the form that is designated to your childs condition based on the clinics approval and diagnosis to your childs heath. If you have any questions please call us.

Please fill out the forms to your best ability. Required information fields will be marked with an asterisk *

West End Clinic

1120 Seven Lakes Dr
West End, NC 27376
(910) 673-5437

Albemarle Clinic

1021 Old Charlotte Rd
Albemarle, NC 28002
(910) 673-5437

Southern Pines Clinic

515 Midland Rd
Southern Pines, NC 28388
(910) 673-5437

Rockingham Clinic

325 South Long Drive
Rockingham, NC 28379
(910) 673-5437

Troy Clinic

707 Albemarle Rd
Troy, NC 27371
(910) 673-5437

Autism Center

1116 Seven Lakes Drive
West End, NC 27376
(910) 673-5437

Hear what some of our parents are saying

Get in Touch!

If you are concerned about your child’s motor skills, communication, language, behavior skills, or any other skill, don’t wait any longer. Reach out and talk to one of our clinic staff today!