PATIENT INTAKE FORMS

Case History Form

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PHI Disclosure Consent to Treat

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HIPAA Notice Acknowledgement and Consent

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Insurance and Fees Agreement

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Requirements for Non-Network Claims

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Opt Out Insurance Filing

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Parent Responsibility & Authorization Form

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Have questions about your child’s speech and language skills? Please contact us!

We are happy to answer your questions and guide you in the right next step for you. We can schedule a speech and language assessment to determine if your child would benefit from speech and language therapy. If you have a current speech and language assessment, we may be able to go ahead and schedule weekly treatment sessions.