Initial Intake Forms

Please complete the forms listed below and bring to your initial appointment. Select one of the three Patient Registration forms according to the payer source- Medical insurance, Auto insurance, or Workman's compensation depending on your situation.

Registration form Medical Insurance

Registration form Auto related

Registration form- Work Comp related

Medical History

List of Medications

Communication with Others

No Show Policy

Insurance Verification Form (please read for your information)

Acknowledgement of Receipt of Insurance Verification (please print and sign)

Privacy Policy

Please read the "Privacy Policy". You do not need to print it out or bring it with you. However, please sign the "Acknowledgement of Receipt of Privacy Policy" form and bring it to your initial appointment.

Privacy Policy (please read for your information)

Acknowledgement of Receipt of Privacy Policy (please print and sign)

Patient History Form for Speech Therapy

Please complete the particular form identified in the email & bring to your initial appointment.

Academic History Form

Patient History Form

Release of Information