Complete this secure form if you have concerns about your child’s (toddler or preschooler) ability to communicate. You will need:

  • Credit card for required appointment deposit of $35
  • Photo of insurance card (Does Atlanta Speech Therapy accept my insurance?)
  • Individualized Education Plan (required by all Medicaid insurance, if applicable)
  • Pediatrician referral for evaluation and treatment of speech and language (ask doctor’s office to fax to 888-975-7556)
  • Contact information of specialists working with child (if any)
  • (download this form if you prefer to mail or fax your child’s case history to our office)