Valley Family: Coopersburg
551 E. Station Avenue
Coopersburg, PA 18036
Office: 484-863-9220
Fax: 484-353-5157


Valley Family: Emmaus
431 Chestnut Street
Emmaus, PA 18049
Office: 484-863-9220
Fax: 484-353-5157
We proudly provide services in 2 locations:

Valley Family Therapeutics, LLC  
Outpatient Pediatric Therapy Clinic: PT, OT & SLP

Pediatric Therapy Clinic and Learning Academy
551 E. Station Avenue
Coopersburg, PA 18036
(484) 863-9220
valleyfamily@mail.com

Prescription for Services:


Please provide a Prescription to your child's Pediatrician. Click here to download.

It must be received prior to the first visit and for pre-authorization of services.

It can be:

Faxed: (484) 353-5157

Emailed: valleyfamilytherapy@gmail.com


Thank you!


Permission to Treat Form:


Please fill out this form and bring with to first treatment session. Click  here to download.

It can be:

Faxed: (484) 353-5157

Emailed: valleyfamilytherapy@gmail.com


Thank you!


Patient Intake Form:


Please fill out this form and bring with to first treatment session. Click here to download.

It can be:

Faxed: (484) 353-5157

Email: valleyfamilytherapy@gmail.com


Thank you!


Financial Agreement and Insurance


Please click this link to download our Financial Agreement and Insurance Form

Once complete, please return to us via:

Fax: (484) 353-5157

Email: valleyfamilytherapy@gmail.com


Thank You!


Photo Consent Form:


Please fill out this form and bring with to first treatment session. Click here to download.

It can be:

Faxed: (484) 353-5157

Email: valleyfamilytherapy@gmail.com


Thank you!


HIPPA Release Form:


Please fill out this form and bring with to first treatment session. Click here to download.

It can be:

Faxed: (484) 353-5157

Email: valleyfamilytherapy@gmail.com


Thank you!


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Insurance Pre-authorization form:


Please click this link to download our insurance form.

Once complete, please return to us via:

Fax: (484) 353-5157

Email: Valleyfamilytherapy@gmail.com


Please provide a copy (you can email a photo of it from your phone) of the front and back of your insurance card as well.  Thank you!


Learning Academy Brochure


For more information about our Learning Academy download our brochure here or call anytime at (484) 863-9220



Class registration form:


Please click this link.  

Once complete, please return to us via:

Fax: (484) 353-5157

Email: Valleyfamilytherapy@gmail.com



Autism Screening Child/Family Intake


Please click this link

Once complete, please return to us via:

Fax:(484) 353-5157

Email: Valleyfamilytherapy@gmail.com


Feeding Intake


Please click this link

Once complete, please return to us via:

Fax: (484) 353-5157

Email: Valleyfamilytherapy@gmail.com





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