Refer a Patient to Knights of Columbus

After receiving your patient’s referral, the family will be called and/or will receive a confirmation letter. Please inform the family that the wait list is lengthy, and they will again be called when it is time to schedule. If the child receives an appointment elsewhere while on the wait list, please contact us so they can be removed from the list.

In addition to the form below, we ask that the patient’s insurance card and the PCP’s most recently well visit notes be faxed to Knights of Columbus. If you have any questions, please call us at 314-577-5609.

Please enter as MM/DD/YY
Please enter a five-digit ZIP code
Please enter phone number as XXX-XXX-XXXX
Please fax a copy of the insurance card with referral to 314-678-4474




Must select at least one




Must select at least one













Must select at least one
Our therapists conduct developmental testing with the children and orders are required to complete the comprehensive evaluation process.
Our therapists conduct developmental testing with the children and orders are required to complete the comprehensive evaluation process.

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Why do we ask?