AHO

Join the Waitlist

Fill out the form below and our team will follow up within 1-2 business days.

Client Information

Who is this inquiry for?

First Name*

Last Name*

Date of Birth*

Used to calculate age and match with the right clinician.

Gender

Optional — helps clinicians prepare appropriate materials.

Is this for a child or an adult?*

Child (under 18)Adult (18+)

Phone Number*

Email Address*

Mailing Address

Optional — used for mailings and home-visit logistics.

Preferred Language

Do you need an interpreter?No

What service are you looking for?

Service*

Speech TherapyOccupational TherapyBoth Speech & OT

Speech helps with communication, language, and feeding. OT helps with motor skills, sensory processing, and daily skills.

How did you hear about us?

Concerns or goals

Preferred Clinician

Leave blank if no preference.

Insurance

We'll verify coverage before your first visit.

Primary Insurance*

Member ID

From the front of the insurance card. You can leave this blank and add it later.

Is the subscriber the same as the patient?

No — different person (parent or guardian)

For most children the parent is the subscriber. For adults usually it's the patient themselves.

Subscriber Name

Subscriber Date of Birth

Do you have secondary insurance?No

Where would you like to be seen?

Preferred Location*

Dearborn (In-Person)Ann Arbor (In-Person)Virtual

Before you submit

I understand that wait times vary and that someone from Anwar House of Therapy will contact me within 1-2 business days. I authorize AHT to store my contact and insurance information for the purpose of scheduling services.

By submitting, you agree that Anwar House of Therapy may contact you at the phone or email provided. Questions? Call (734) 224-9121.