New Client Forms

To assist you with getting the most out of your first visit to us, please complete the 2 (or 3) important tasks below:

1.  New Client Form – Please print and fill out.  This form will provide us important information regarding your child’s developmental and medical history.  Bring this with you along with your insurance information.

New Client Form

 

2.  Physician’s Prescription – We do require a physician’s prescription be on file prior to any first visit with us.  We will contact your child’s doctor for you, but in some cases we may need your assistance.  If your child has not seen their physician in a while, some doctors may require this in advance of writing a prescription.  If you will be seeing your physician for this purpose, he/she can fax their prescription to us at 615-377-1625.  We have included a Physician Referral Form below for your convenience.

Physician Referral Form

 

3. Speech and Language Caregiver Questionnaire (Conditional) – If you are seeing us for a Speech and Language evaluation, your evaluating therapist may ask that you complete this Speech and Language Caregiver Questionnaire.  Completing it prior to your visit with us will save you time at check-in.

SLP Caregiver Questionnaire

 

We love to hear from you about the progress you see your child making. Please take a moment and write a short Success Story. It gives us great joy to know we’ve helped make a difference!

Success Story Form