Forms + Policies

Forms:

To allow as much time as possible for your child’s evaluation, please complete the paperwork below prior to your appointment. Your cooperation is greatly appreciated!

General forms for all patients:

Please choose the appropriate form based on your primary concern or the child’s age:

Policies:

Financial Information and Billing:

As a courtesy, A Speech Path will bill the following insurance companies:

  • Premera Blue Cross
  • Regence Blue Shield
  • Aetna

(For all others, appropriate documentation can be provided to submit for reimbursement.)

While A Speech Path is happy to bill the above-named insurance companies for all services rendered, your coverage is an agreement between you and the insurance company. I will work with you and the insurance company to resolve any of your denied claims; however, all unpaid portions are your responsibility and payment is expected within 21 days of billing.

Please contact A Speech Path regarding specific questions about financial information.

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