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  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 or 561-214-4962.

 

Thank you,

The Administration

COVID Screening Form

Telehealth Consent FORM

Telehealth Billing Form

Registration Form 2019

Medical Hx Form 2019

Cancellation Policy 2019

HIPAA FORM 2019

Parental Photo Video Consent Form 2019

Credit Card Agreement 2019

 

 

 

We accept the following insurances:

  • CIGNA
  • UNITED HEALTHCARE
  • AETNA
  • MIAMI CHILDREN HEALTH PLAN
  • PRESTIGE
  • STAYWELL/WELLCARE

We strongly recommend that you contact your insurance company to confirm that they cover speech therapy, occupational therapy and/or physical therapy.