Complete this form secure form if you have concerns about your ability to communicate. You will need:

  • Approximately 20 minutes to complete
  • Photo of insurance card (Does Atlanta Speech Therapy accept my insurance?)
  • Contact information of specialists your are working with (if any)
  • Primary Care Physician referral* for evaluation and treatment of speech and language (or fax to 888-975-7556)
  • Credit card ($35 appointment deposit)
*omit if insurance will not be billed