To Get Started
Your child’s file must be complete with all items prior to starting therapy.
- Prescription from your child’s primary care physician with ICD-9 code for a diagnosis and frequency of visits.
- Current Evaluation from your previous Speech, Occupational or Physical Therapist, less than 12 months old.
- Case History Form
- Financial Agreement
- Privacy Policy
- Insurance Information: please copy the front and back of your primary and secondary insurance.
- Medicaid Information: a copy of Medicaid card and a copy of the current months eligibility form*
- Preauthorization: Please check with your insurance company to see if they require preauthorization**
- Current IFSP: if ages 0 to 3 years and participating in the Georgia Babies Can’t Wait Program
* Medicaid Information: Traditional Medicaid, Deeming Waiver, Peachcare for Kids, or CMO.
** Preauthorization: If preauthorization is required, you will need to go through this process prior to beginning therapy.
** Preauthorization: If preauthorization is required, you will need to go through this process prior to beginning therapy.
Patient Forms
- Financial Agreement
- Case History
- Patient Information
- Privacy Form (HIPPA)
- Acknowledgement of Receipt of Privacy Practices
Vea en español
Teletherapy Forms
Listening Skills Forms
Insurance
We are currently in-network with these insurance plans:
- BCBS of Georgia (or other states), PPO & POS plans
- Tricare South
- Humana
- Cigna through Health Partners or NEGHS
- All Medicaid CMO’s except for WellCare
- Peachcare for Kids and Ambetter