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Clinic Forms

Form Download Instructions

  1. Click on each button

  2. Complete the answers in each blank

  3. Save a copy to your desktop with your Last name

  4. Email me at

  5. Attach each saved file from your desktop.


I am an in-network provider with the insurance companies listed below. Many insurance companies also offer out-of-network benefits for speech therapy. 

Friday Logo.png
Cigna Logo.jpg
Medicaid Logo.jpg
UHC logo.png
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