(281) 674-4205 Office (480) 287-7759 FAX
(281) 674-4205 Office (480) 287-7759 FAX
In preparation for your child's speech therapy evaluation your speech therapist requests that you download all the forms below and return them along with a copy of your child's latest school ARD meeting record and school speech therapy goals and progress report via fax to (480) 287-8474. Do not email your completed forms as email is not HIPPA compliant.
Speech Inspiration Pediatric Questionnaire Form (pdf)
DownloadSpeech Inspiration Authorization for Speech Language Treatment (pdf)
DownloadSpeech Inspiration Registration Form (pdf)
DownloadSpeech Inspiration HIPPA Privacy Notice (pdf)
DownloadNotice of Privacy Practices Acknowledgment Form (pdf)
DownloadSpeech Inspiration Referral Form (pdf)
DownloadWelcome to Speech Inspiration Pediatric Policy 2018 (pdf)
DownloadSpeech Inspiration Authorization to Obtain Information (pdf)
DownloadSpeech Inspiration Release of Information (pdf)
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