Welcome to Communication Interventions, Inc. We are so pleased that you have chosen us for your child’s speech therapy or mindfulness coaching needs. Be assured that every effort will be made to insure that their experience is both a productive and a pleasant one. Our goal is to support the goals designed for the child and family. There are a few things that we will need to obtain from you before or at the first scheduled visit. Please download the “Patient Information Packet." Each sheet is very important, and therefore we ask that you read them carefully and complete them as accurately as possible. If there is a portion that does not apply, simply enter “NA”. Please review the items listed below, and be sure that we have the items that apply to our office by your initial visit.
Therapy cannot begin unless we have all of the following on file:
Patient Information Form
Medical Case History Form
Assignment of Benefits and Consent to Treat Form (this includes the billing, late fees, insurance, fee schedule, and cancellation policies- PLEASE SIGN AND RETURN)
ACH/Auto Draft Form
Rates, Fees, and Policy Agreement (READ ONLY)
Copy of insurance card-front and back (if applicable)
Copy of Medicaid card (if applicable)
IEP goal page(s) if applicable
BILLING: We will be happy to check on benefits and bill your insurance company for you and determine *if* you have out-of-network benefits. However, you are responsible for any unpaid balances or co-pays that your insurance does not cover/pay. If you have any concerns or questions about this, please review the Rates and Policies Form (see below).
Please contact us at email@example.com or call (404)720-4278 if you have any questions.
The Team at Communication Interventions
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