Forms + Policies


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:


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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