Intake Documents
Please complete the necessary intake forms prior to your appointment to ensure a smooth and efficient check-in process.
Intake Forms
Please complete the necessary intake forms prior to your appointment. Use the online PDF filler to complete and submit your forms digitally.
English Intake Form
Complete the intake form in English prior to your appointment.
Download & Fill FormFormulario de Admisión
Complete el formulario de admisión en español antes de su cita.
Descargar y LlenarAttendance & Cancellation Policy
Consistent attendance is a condition of receiving speech therapy services. Missed appointments disrupt clinical progress and limit availability for other clients.
Appointment Attendance
Clients are expected to attend all scheduled appointments. Repeated missed appointments may result in discharge from services. The first (1st) no-show appointment will be excused as a one-time courtesy.
Cancellations
All appointment cancellations must be made at least twenty-four (24) hours in advance of the scheduled appointment time. If office staff cannot be reached, the client or responsible party must leave a voicemail that includes client’s full name, date of birth, appointment date and time, and return phone number. After the second (2nd) late cancellation (less than 24 hours’ notice), a $35 late cancellation fee will be assessed per occurrence. These fees are not covered by insurance and must be paid in full no later than the next scheduled appointment in order for services to continue.
No Call / No Show
Failure to attend an appointment without prior notice will result in a $55 no-show fee per occurrence.
Emergencies
Emergencies are still subject to a late cancellation fee of $35.
Late Arrivals
Clients arriving more than fifteen (15) minutes late will be considered a missed appointment and will not be seen. Late arrival fees may apply.
Waived Fees
Clients with Medicaid or IEHP will not be charged late cancellation or no-show fees; however, attendance requirements and discharge policies still apply.
Three-Strike Rule
A total of three (3) late cancellations/late cancelled reschedules and/or no-shows within a ninety (90) day period will result in automatic discharge from services and cancellation of all future appointments. Reinstatement is not guaranteed.