ph icon2Forms and Insurance

Insurance & Registration Information:

Powerhouse Therapy is in-network with Blue Cross Blue Shield and Tricare. All other insurance companies are out of network. We will be happy to run your benefits to see what your coverage will be for our program. Cost of the program is also accepted with HSA.

Fill out and sign Registration Form, Emergency Medical Release, Medical Referral Form, and Consent to treat. Return Insurance form if you would like to bill insurance.

Payment Information:

A $1,050 deposit is due at the time of registration, which includes a $50 application fee. Your deposit and Registration Form ensures your child’s spot in our program.

Payments are accepted via credit card or checks mailed to:
Powerhouse Therapy, 1525 Haven Crest Drive, Powder Springs, Georgia 30127

We also accept Venmo payments to 404-933-9869.


3735 Kennent Square,
Suwanee, Georgia 30024

Download Patient Forms

Registration Form

Insurance Form

Emergency Medical Release Form

Consent to Treat

Medical Referral Form