FREE Forms

  • Super Bill – Invoice to client (They can turn in to insurance for reimbursement)
  • Evaluation explanation Letter in English and Spanish
  • Letter in Spanish asking client to call you to set up evaluation    
  • Infection Control
  • Clinic Rules for Clients
  • Frequent Absence Letter (Please don’t miss therapy)
  • Payment Responsibility Notification
  • Accident/Incident Report
  • Information for Observing / Clinical Therapy Students
  • Free Developmental Screening Offer Letter
  • Short Data Intake Form
  • Warning of Termination of Therapy Letter in English and Spanish
  • Absence Excuse
  • Evaluation Performed-for Internal use and tracking
  • Evaluation enclosed letter to client
  • HIPAA – Confidentiality Agreement for 1099 Contract Therapist
  • Practice Mission Statement
  • Patient Information Release
  • Appointment Reminder Postcard
  • Questions to ask your insurance about therapy coverage (To give to clients)
  • Speech and Language Development Checklist
  • Privacy Notice for Clients to sign
  • Photo/Video Release

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Forms that Scott uses in his clinics

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