Complete this secure form if you have concerns about your child’s feeding or diet. If you have not already provided a copy of the listed documents previously, you will need:

  • Photo of insurance card (Which insurances does Atlanta Speech Therapy accept?)
  • Contact information of specialists working with child (if any)
  • Pediatrician referral for evaluation and treatment of dysphagia or feeding therapy (ask doctor’s office to fax to 888-975-7556)
  • Approximately 20 minutes