This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully and keep it for your records

Acknowledgement that you have received our HIPAA privacy notice

This form states you understand participation is voluntary and you assume all risks

This is a patient history form. Please complete it in its entirety before returning to therapist

It is important for us to understand your preferred method of receiving and communicating medical and administrative information pertaining to your therapy

If you have a physician, a previous SLP or a school SLP, an OT, a PT, a teacher, or anyone else who works with your child that would be beneficial for us to speak to, please add their information to this form

Informational form regarding our Prompt Pay Method. Please print and keep for your own records

In order to receive therapy, you must sign the consent for services form indicating your consent

This form should be completed if we will be billing your Medicaid-see form for details. If you you are using our private pay option and plan to pay online, you do not need to complete this form

Photos and videos may be taken during sessions. This form indicates your preference on photos/videos

This form is for your information regarding Superbills. Please print it and keep it for your records

This form indicates you received and signed all other forms provided

This document details our No Show/Cancellation policy and must be signed prior to start of services

If your child is insured by a private insurance company, (any insurance other than Medicaid), please complete this form in its entirety