Forms

If you plan on using insurance, we need the following documents:

1. Physician’s Order for Speech Evaluation and Therapy Including your child’s diagnostic code faxed to 316-462-0999.

EXAMPLE:
Speech Evaluation and Therapy for Mary Smith
Developmental Speech Delay 315.39
Feeding Disturbance 783.3

2. A copy of your insurance card at first visit.

3. Fill out the forms below and bring them to your first appointment.

Thank you for your interest in Small Talk Pediatric Speech Therapy.