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:
- Birth-Preschool History Form
- Kindergarten-18 years History Form
- Childhood Fluency/Stuttering History Form
Financial Information and Billing:
As a courtesy, A Speech Path will bill the following insurance companies:
- Premera Blue Cross
- Regence Blue Shield
(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.