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Getting started with Tribe

We look forward to working with you!

New Child Request for Services

Free Online Screening

Private Pay Sliding Fee Application

Volunteer Forms

Located in Historic Riverside:

2103 Gilmore Street

Jacksonville, Florida 32204

tribe@inthetribe.net

Phone: (904) 906-3878

Fax: (904) 770-5596

Monday - Thursday

Opening Hours

Friday

8:30 am – 5:00 pm

8:30 am – 12:30 pm

Saturday and Sunday

Closed

Super Hero Kids

New Patient Contact Form
Children Ages
Birth - Five

Hello! We’re thrilled to have you join our Tribe. Please take a moment to fill out our contact form. It’s crucial to provide all the requested information. Once we’ve verified your insurance benefits, we’ll reach out to schedule an appointment. If you have any questions or need to follow up, feel free to call us at 904-906-0178. We’re excited to begin this journey with you! 🌟

New Patient Contact Form

Contact Form
Children Ages Birth - Five Years

Caregiver's First Name

Caregiver's Last Name

Caregiver's Email

Child's First Name

Child's Last Name

Child's Birthday

Street Address

City

Region/State/Province

Postal / Zip code

CAREGIVER Phone

Pediatrician's Name

Pediatrician's Phone

Primary Insurance Name

Secondary Insurance ID Number

Primary Insurance ID Number

Secondary Insurance Name

What are your concerns about your child?

Please list any diagnoses your child has:

What therpy are you wanting? Check all that apply.

Speech Therapy

Occupational Therapy

Physical Therapy

Feeding Therapy

Toddler Playgroups

I agree to receive text messages from this business

Thanks for submitting!

Volunteer with Us

Thank you for your interest in volunteering with our Tribe.
All volunteers must clear a background check before beginning.
This process requires your social security number and driver’s license.
We will run the background check within the next few business days and notify you via email when you are cleared to volunteer. If you have any questions, please feel free to email us at officebillingtribe@gmail.com. We are excited to work with you🤝

First Name

Last Name

Email

Phone

Social Security Number

Driver's License Front

Upload File

Upload supported file (Max 15MB)

Driver's License Back

Upload File

Upload supported file (Max 15MB)

Which days are you available?

Mon

Tue

Wed

Thu

Fri

Flexible

A few words about you

Thanks for applying with us! We'll get back to you soon.

Volunteer

Tribe Rehabilitation 2023

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