New Patient Form
All new patients must fill out this form before arriving to the office. If the form is not filled out prior to your arrival, you may need to reschedule as it may cause delays in scheduling. Please allow 15 -20 minutes to fill out this form.
This form may take 15 - 20 minutes to fill out. Please set aside this amount of time prior to starting. You will need your insurance information (if you have insurance). *
Required
Speech Pedals is currently in-network with Tricare and United Health only. We can courtesy bill other insurance companies on your behalf although this does not gaurantee that your insurance company will pay for speech services
All information in this form is confidential and protected. *
Required
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