Welcome to SpeechLink!

Thank you for choosing SpeechLink to help meet your speech language pathology needs. We realize there are many options from which to choose and we appreciate the opportunity to assist you with this important process. Please take time to fill out as much information as possible regarding your history as this information can be vital to the direction of the therapy plan. We understand that these forms can be time consuming; however, it is important that your therapist have as much information as possible prior to our first meeting so that she may provide the best possible service for you.

Adult Speech Therapy Intake Form

Patient Information

Medical Information

Speech, Language, and Communication

Swallowing (Dysphagia)

Cognitive-Communication

SpeechLink Policies & Procedures

Cancellation Policy

If you must cancel an appointment, please call immediately. Except under emergency circumstances and acute illness, all appointments cancelled with less than 24 hours notice will be subject to a service fee of $85 for evaluations and $65.00 for therapy sessions. There will be ONE “failure to cancel/NO show” courtesy provided. If you arrive late for your appointment, we will do our best to see you, however the appointment may be shortened due to the therapist’s schedule; the full session fee still applies. Please note that most insurance companies will not reimburse for missed appointments and you will remain responsible for these charges

Termination of Services

Due to the importance of continuity of care, regular attendance to appointments is necessary. If excessive appointments are missed and/or canceled, SpeechLink reserves the right to discharge services. Verbal and written notice will be provided. Optimal outcomes are always our goal; however, SpeechLink does not guarantee results.

Health Policy

Help and cooperation is required to maintain a healthy environment. The client must be temperature-free for 24 hours before returning to therapy. If you have been vomiting and/or have diarrhea, please do not return to therapy until 24 hours have passed since the last episode.

Final Consent & Acknowledgment

By signing below, I acknowledge that I have read and understand all SpeechLink policies and consents, including the cancellation, payment, confidentiality, and health policies above. I consent to receive treatment as outlined and acknowledge receipt of the Privacy Policy, Patient Rights, and Procedures.