New Patients

To get started with speech therapy services including screening, evaluation, and treatment, we ask that you submit the following preliminary paperwork included in this document.

A copy of the front and back of the policy holder’s insurance card.
A copy of the front and back of the child / patient’s insurance card.
Case History (pediatric or Adult)
New Patient Forms
- Consent for Treatment
- Consent for Release of Information
- Cancellation & Attendance Policy
- Appointment Reminders
- Photograph & Video Consent
- Insurance/Payment Information & Authorization
- HIPAA Privacy Policy

Please complete the Case History Form to the best of your ability. This will help us better understand the needs of your child. We look forward to working with you. Please do not hesitate to call or email us with questions. You may email, mail, or fax the completed paperwork.

info@speechcenterofkaty.com

p: 281-758-8793

f: 832-437-5352

Speech Center of Katy

27524 Westridge Creek Lane

Katy,TX 77494