Blackbird Health
  • Welcome Image

    Welcome! We’re so glad you found us.

    Please fill out this brief form, and we’ll get back to you as soon as we can—always within one business day.

    Here’s what to expect:

    • Share a bit about yourself or your child, and your insurance
    • We’ll verify your insurance and contact you to schedule
    • Most families are offered an intake appointment within one week
  • Who are you looking to get services for?*
  • Patient's Date of Birth*
     - -
  • Format: (000) 000-0000.
  • It looks like you reside outside of Pennsylvania and Virginia. Can you travel to PA or VA for all appointments?*

  • We're sorry to hear that.

    Unfortunately, we can only offer services in states where our providers are licensed. If you're able to visit one of our locations in PA or VA, please submit this form to connect with a member of our staff to get scheduled.

  • Can you give us some information about yourself?

  • Are you over the age of 13?*

  • We're sorry, it looks like you are under the age of 13. A legal guardian must complete the form on your behalf.

  • Great! Let's get some more information.

  • Format: (000) 000-0000.
  • Your Date of Birth*
     - -
  • It looks like you reside outside of Pennsylvania and Virginia. Can you travel to PA or VA for all appointments?*
  • What services are you looking for?*
  • How did you hear about us?*

  • Thank you! Can you tell us a bit more about the provider that referred you?

  • In an effort to provide best in class care to as many kids and families as possible, Blackbird accepts most commercial insurances. Do you intend to use insurance to cover appointments?*
  • We currently do not accept coverage for this type of insurance. We do offer out of pocket payment for services. Are you still interested in moving forward or learning about our cash options?*

  • If at any time you wish to come back to us- please don't hesitate to reach out!

  • We collect your insurance information now to verify coverage before your care begins. If your plan has restrictions that affect billing or scheduling, we’ll let you know.

  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof
  • Do any of the below statements apply? If so, please check them. We only use this information in an effort to best support the patient through this transition.
  • Should be Empty: