Appointment Checklist



Office will need to receive a prescription from MD for requested medical services.  Rx may read "ST to eval and tx for (insert dx code)"

Rx must be dated within 6 months of scheduled office visit.

Fax 404-937-6296

Case history forms

Office will need to receive completed case history forms prior to scheduling first appointment.

Email the office at with your contact info and preferred email address to request forms.

When calling the office at 404-590-1237 please always leave a message for a response.

Fax completed forms to 404-937-6296

Recent evaluation(s) and records

Office will need to receive newborn hearing screening or audiological assessment for pediatric patients with insurance CMO.

Office will need to receive any recent evaluation reports and records supporting medical necessity for requested service.  Provide the office with any applicable documents from previous SLP, PT, OT, psychological report, school IEP, or neurological documents. 

In some cases a recent evaluation may be accepted by the office along with Rx or referral to initiate treatment services.

Fax 404-937-6296

Insurance information

Office will need to receive a copy of insurance card (front and back) to verify benefits.


Credit card authorization

Office will need to receive credit card authorization.  Line item on the appointment checklist is nonrefundable and received upon establishing the first scheduled appointment.  

Client or authorized party is responsible for any fees deemed subscriber's liability (not covered by insurance).


Feel free to contact the office with any questions. Please always leave a message for a returned call or timely response.

Office contact 404-590-1237

Office fax 404-937-6296