Insurance Form
Please fill out the information for your insurance on the form below. Once you have scheduled an initial appointment, Talk SLP LLC must receive this form at least 3-5 days before your appointment.
Thank you.
Please also see our Insurance and Billing page for more information about your insurance and our policies.
Disclaimer:
Speech and Language and Orofacial Myofunctional services are not always a covered benefit with your insurance company and may even be considered not medically necessary. A quote of benefits from your insurance company is not a guarantee of payment and should services be denied, the patient/family is ultimately responsible for payment. You are also responsible for payment of any deductible, coinsurance or copayment as applied by your insurance. If your account is ever sent to Outside Collections for non-payment, you will also be financially responsible for any collection fees.
By submitting this form, you are providing consent to Talk SLP, LLC to contact your insurance company on your behalf for information about coverage of the service(s) provided.