All forms need to be filled out.
This letter provides information to new clients on what to expect about therapy and a highlight of important things to know.
This form provides developmental milestones and information necessary to better understand your child as we move forward.
Consent And Release Of Information
This form provides consent for ASTS to provide services to your child and communicate with other therapists or school/teachers (if applicable) to work as a team.
Please fill this out - no matter what insurance carrier you have - so that in the event of needing to default to a Teletherapy session we are covered. If you have a commercial insurance please cross out GA MED and write your carrier and policy number on the line. Please write “speech therapy” on the line under PURPOSE. Then just sign and date the bottom.
Policy & Financial Agreement Form
This form explains the policies and procedures of ASTS so that you are aware of how your claims will be processed and payment expectations. It also discusses scheduled appointments and missed appointments. Signing this document expresses your understanding of all the bullet points listed.
Credit/Debit Card Authorization
This form is to not only provide a credit card on file for monthly invoices (if you choose to do so) but it also is a back up for ASTS in case of non-payment. Your card will never be charged without your knowledge but signing it allows us to process a payment if you have exceeded a reasonable amount of time despite friendly reminders to pay. You always have two weeks from the date emailed to you. **Please note that the use of any credit card will add a processing fee.