New Patient Forms

We know you hate patient forms.

We do too, but new patient forms are necessary for our business and for the protection of your child. And quite frankly, some of the information collected is required by law.

The two patient forms that need to be filled out prior to the initial evaluation or therapy are right here for your convenience.

Click on the purple links,  download the files (directions below), print, fill in the blanks, and bring the forms in when you have your first appointment at Kidmunicate.

If you would like access to a secure fillable/signable reform, send a request to admin@kidmunicate.com.

We accept some forms of insurance. We would be happy to evaluate your insurance situation as it pertains to insurance. After we receive information from you to complete this insurance review, we will send you an eform that you will be required to sign prior to treatment.

Kidmunicate New Patient Information and Consent Form

What to expect:

• Patient name and address
• Parent / guardian contact information
• Insurance information
• Consent to treatment
• Financial responsibility and payment terms
• Cancellation policy
• HIPAA forms

Kidmunicate New Patient Speech History Form

What to expect:

• Home and school information
• Relevant medical history
• List of other specialists working with your child
• Developmental history

Download Directions

• Click on the purple link above and the form will show up on your screen.
• Hover your cursor over the document. When you do a bar pops up on the bottom. You have two options.
  • Click on the icon that looks like a computer disk and save the file to your desktop
  • Click on the icon that looks like a printer to print the form on your home printer.