Appointment/Evaluation Request
*Fill out the following forms ONLY if you have an appointment scheduled
New Patient Information and Polices*
New Patient Medical History & Concerns*
Authorization to Disclose Medical Records (Use to add new facility, practice, or person)
We are an in-network provider for:
Anthem Blue Cross Blue Shield
Tricare
Private Pay: Give us a call or email for current private pay rates: 719-999-8417.
We have created this worksheet to help you determine if your health plan will cover speech therapy. We strongly encourage you to use this when calling your insurance company, it will help avoid possible problems
Worksheet: Does my Insurance Cover Speech Therapy