Please print the appropriate forms (below) and fax or email them to us, along with a photocopy of the front and back of your driver’s license and insurance card(s). Our administrative team will call to verify your insurance coverage. Once received, we will call you to schedule your evaluation. After the evaluation, our therapist will make recommendations regarding therapy and treatment programming.
Please print and complete the appropriate form(s), make front/back copies of your driver’s license and insurance card(s), and send to email@example.com or fax to (936)703-5065.
Babel Pediatric Intake Packet (pdf)Download
Adult Congenital Intake - Patient has a disorder affecting their communication since birth (pdf)Download
Adult Acquired Intake - Patient has accident or diagnosis affecting communication later in life (pdf)Download
Credit Card Authuthorization Form (pdf)Download
Change of Providers (pdf)Download
Consent to Exchange Information (pdf)Download
Speech therapy prescription (pdf)Download