Look Who's Talking

Pediatric Speech Therapy
Home
About Us
Contact Us
Site Map
New Client Forms
Speech and Language Checklist
Useful Links
Glossary of Terms
New Client Forms
 
 
Other things to have ready for your first session:
*a photocopy of insurance/medicaid card front and back
*a prescription from your doctor requesting speech therapy with a diagnosis and frequency of therapy 

Please print out these forms and fill out to have ready for our first session.

 

New Client Forms:

/Documents/Authorization to discuss patient info.doc

/Documents/Billing agreement.doc

/Documents/Client Hx form.doc

/Documents/HIPPA disclosure.doc

/Documents/Notice of Privacy Practices.doc