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.  We have a secure online form, as well as, a printable version.   Please take a moment and fill out our Insurance Verification Form, and we will be in touch with you within 1-2 business days.  If you opt to print and fill it out, please fax or mail it directly 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.  We have a secure online form, as well as, a printable version.  Please fill out our Pediatric History Form, and we will be in touch with you shortly to schedule an appointment.  If you opt to print and fill it out, please fax or mail it directly 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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