"BASLAW" is now known as "Speech Therapy and Accent Group"


Forms

We're looking forward to getting started with you! Please print, fill out and return the following forms before your first session.

The following forms are required for pediatric services:

  • Acknowledgment HIPAA Privacy Notice
  • Attendance Cancellation Policy
  • Child Intake Form
  • Communication Preference Form
  • Credit Card Authorization
  • Notice of Privacy Practices
  • Payment Policy

The following forms are required for adult therapy services:

  • Acknowledgement HIPAA Privacy Notice
  • Adult Therapy Intake Form
  • Attendance Cancellation Policy
  • Communication Preference Form
  • Credit Card Authorization
  • Notice of Privacy Practices
  • Payment Policy

The following forms are required for adult coaching services:

  • Acknowledgement HIPAA Privacy Notice
  • Attendance Cancellation Policy
  • Communication Preference Form
  • Credit Card Authorization
  • Notice of Privacy Practices
  • Payment Policy
  • Weekly Coaching Sheet