Forms

Parents,

We are happy that you have chosen Theraspeech, Inc. to address your child’s developmental needs!

Our therapists aim to accommodate all families when it comes to scheduling.  We take in consideration your time and want this experience to be a good one.  Therefore, to facilitate delivery of services, we suggest that you print, read and complete the documents listed below prior to your scheduled appointment.  In addition to the forms, we ask that you also have a prescription or referral from your child’s pediatrician.

We have always been very accommodating and understand that you may have unexpected circumstances that require you canceling your appointment.  However,  to manage last minute cancellations and no shows, we will charge $35 for cancellations up to 3 hours prior to your session unless you are able to reschedule your appointment.  We reserve the right to remove your child from the caseload as stated in the policy document due to excessive cancellations.  We are available to answer any questions or concerns you may have regarding the information presented in these documents.  Please carefully read and sign the forms that are listed below. Return the packet prior to your appointment via email to aleana@theraspeechinc.com or fax to 561-242-4340.

 

Thank you,

The Administration

Registration Form 2019

Medical Hx Form 2019

Cancellation Policy 2019

HIPAA FORM 2019

Parental Photo Video Consent Form 2019

Credit Card Agreement 2019

Private Pay

A 15% discount is available when multiple sessions are purchased at the beginning of the month.  Please contact Ali Carty for additional information aleana@theraspeechinc.com

Insurance 

Theraspeech Inc. is in-network with the following insurance companies: