Forms

All forms must be submitted prior to the client’s initial evaluation or beginning services. Please return completed forms to kidsexpressspeech@gmail.com or give them to the clinician in person at the first appointment.

To provide the highest quality care possible, I do not accept evaluations from other providers and require completing an evaluation prior to starting speech therapy services. This is standard industry practice and will produce the best results for your child.

Client Information

Case History Form

Authorization to Release Information

HIPAA Policy (keep for your files)

HIPAA Policy Acknowledgement

Credit Card Authorization

Cancellation Policy

Permission for Screening