COVID-19

We are currently seeing patients via teletherapy sessions and some in office sessions. If you would like to schedule a session, please call 586-8030.

Initial Intake Forms

Please complete the forms listed below and bring to your initial appointment. Select one of the three Patient Registration forms according to the payer source- Medical insurance, Auto insurance, or Workman's compensation depending on your situation.

Registration form Medical Insurance

Registration form Auto related

Registration form- Work Comp related

Medical History

List of Medications

Communication with Family

No Show Policy

Insurance-Acknowledgement of Receipt of Insurance Verification Benefits

Insurance Verification Form-Please read for your information

Privacy Policy

Please read the privacy policy, you do not need to print it out. Sign and bring the signed Acknowledgement of Receipt at your initial appointment.

Acknowledgement of Receipt of Privacy Policy- print and sign

Privacy Policy- Please read for your information- No need to print & Return to Neuro Rehab Associate

Patient History Form for Speech Therapy

Please complete the particular form identified in the email & bring to your initial appointment.

Academic History Form

Patient History Form

Release of Information