Speech Language Pathologists
in Issaquah Washington

New Patient Forms

We understand that your time is very valuable so we’ve created electronic intake forms which you can securely complete on-line and submit directly to us in advance of your child’s initial appointment. As we continue our clinic’s efforts to “Go Green” and in the spirit of saving our trees, we prefer paperless intake.

Further, should your insurance require it, please provide us with a referral from your child’s healthcare provider. Please ask your child’s healthcare provider to fax the referral to us at (425) 391-2555.

We require all new patients to have our Registration Form completed and submitted electronically prior to your child’s initial visit so that we can verify insurance benefits. Please note, verification of benefits is not a guarantee insurance will cover our services.

IMPORTANT: It is parent/patient responsibility to have an understanding of coverage (and co-pays when applicable) for rehab therapy and/or neurodevelopmental speech-language therapy.

Please make sure you have also signed our Hitech HIPAA Form which provides consent for electronic correspondence.

Please bring your child’s insurance card to your first appointment for us to copy.

Appointment Form

Fill out the form below to request an appointment. If you'd like to speak with someone immediately you may call us at 425-985-8515.

"*" indicates required fields

Parent's/Guardian's Name*
Child's Name*
Preferred Day(s) of the Week*
Preferred Time(s)*
Have you had a previous evaluation?*
This field is for validation purposes and should be left unchanged.