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 an editable and 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 an editable and 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:
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
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.
