Client Forms

Please complete the following forms and return to us at your earliest convenience.  Should you have any difficulty accessing or submitting the forms, please don’t hesitate to call us at (303) 360-0727.

Step 1: Insurance Verification

We would be happy to assist you in determining eligibility for speech therapy services under your health care plan.  Simply complete the online Insurance Verification Form, and we will be in touch with you within 1-2 business days.

We also have a  printable version of this form that that you can fax, mail or upload directly to us.  Once your form is filled out and saved to your computer, you may upload it directly to us, or print it and fax/mail it to us.

Please disregard this form if you don’t plan to access any benefits.

Step 2: Pediatric History

The Pediatric History Form assists us in allocating the appropriate amount of time for your initial appointment as well as matching your child with a therapist.  Please complete the online Pediatric History Form, and we will be in touch with you shortly to schedule an appointment.

We also have a printable version of this form that that you can fax, mail or upload directly to us.  Once your form is filled out and saved to your computer, you may upload it directly to us, or print it and fax/mail it to us.

Step 3: Additional Information

The following forms can be printed and brought with you to your child’s first appointment:

Pediatric History-Spanish

Notice of Privacy Practices

Notice of Privacy Practices- Spanish

Parent Consent to Release Information

Parent Consent to Release Information-Spanish

Cancellations and Missed Appointments Policy

Cancellations and Missed Appointments -Spanish

Financial Agreement

Financial Agreement- Spanish

Insurance Billing Policy

School-Aged Language and Learning Concerns

 

 

If mailing/faxing forms, please send to:

Lowry Speech Therapy
7701 E. 1st Place, Suite D
Denver, CO 80230

fax: (303)360-0758

 

If you have any questions about the forms or process, please don’t hesitate to Contact Us.

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