Print or email these forms prior to your evaluation


Adult Intake Form

Includes your contact information, medical history, and communication abilities.

Consent for Services

This serves as your permission to render services from Speaking Diligence.

Attendance & Cancellation Policy

Outline of policies regarding attendance and cancellations.

Authorization to Release Information

This document allows or prohibits Speaking Diligence to exchange, obtain or release your medical information.

Acknowledgement of General Forms

This serves as a confirmation that you received all forms in compliance with state and federal regulations.

Acknowledgement of HIPAA Policy

Signing this document serves as evidence that you received our HIPAA Privacy Notice.

HIPAA Privacy Policy

This notice is a description of how your medical information may be used or disclosed in accordance with federal regulations.

Payment Policy

This is an agreement of between you as a client and Speaking Diligence as a provider for payment of provided services.

Affiliations:

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