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New Patient Inquiry

Thank you for reaching out to Alphabet Soup Feeding & Speech Therapy / Rowan Bupp, MS, CCC-SLP. I currently have a waiting list for evaluations. This waiting list is not first come first serve. I consider many factors when scheduling patients, including age and medical urgency. In order to move through this list in the most effective way, I need to gather the following information about your child. Completion of this form, in its entirety will help me most effectively serve our community.

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Email *
Patient's Name *
Patient's date of birth *
Parent's name(s) *
Parent's contact phone *
Who referred you to this office? *
Insurance information

Alphabet Soup is contracted with some, but not all insurance plans. If I am out of network for your child's insurance, this office will provide you with all the necessary documentation and coding for you to submit to your insurance company for possible reimbursement.

As of 2026, I will only be accepting OHP/Medicaid patients who have OPEN CARD. 

Are you planning to use insurance or private pay for your child's therapy? *
If insurance, which plan does your child have? *
Patient information
What concern(s) do you have for your child? *
Has the patient been seen by other therapists (PT, OT, SLP) or an IBCLC? *
If yes, where, and for how long? *
Does your child have any diagnoses that may contribute to their current difficulties or their ability to participate in therapy? *
What else would you like to share about your child and any concerns you may have about them. *

Thank you for taking the time to complete this form.

You will be contacted as soon as a spot becomes available for your child.
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