Intake Form Request

Virtual services · General inquiry

Let's get started

This form is for general inquiries only. Evaluation and therapy are provided online (virtually); Independent Educational Evaluations (IEEs) are conducted in person. Medical or educational records are collected later through a secure process, if needed.

Takes 2–3 minutes

Are you inquiring about an Independent Educational Evaluation (IEE)?

Yes — I'm seeking an Independent Educational Evaluation (IEE)

No — I'm interested in a clinical evaluation and/or therapy services

✓

You're in the right place.

Independent Educational Evaluations are conducted in person and have their own process, timelines, and paperwork — so we keep that information on a dedicated page rather than in this intake. We're sending you there now. If the page doesn't open automatically, use the button below.

Continue to IEE information

Please confirm before continuing:

I understand that evaluation and therapy services are provided virtually (online).

Tell us a little about your family

A few details so we can reach out and confirm the right next step.

1About your care

Which best describes how you plan to pay?

Commercial Insurance (Atlanta Speech Therapy is in-network)

Commercial Insurance (Atlanta Speech Therapy is out-of-network)

Medicaid

Georgia Promise Scholarship

Private pay (self-pay)

Due to current billing challenges for ongoing therapy services with your child's insurance, we can only provide an evaluation. An evaluation can help determine whether your child qualifies for community-based services (early intervention, free preschool, school-based therapy). DO NOT proceed if you are only seeking therapy services with Atlanta Speech Therapy.

2Your contact information

First name

Last name

E-mail address for scheduling and general communication

Confirm your e-mail address

Best phone number to contact you

3About your child

Child's Age Range

Under 3

3–5

6–10

11+

What would you like information about?

Evaluation

Therapy

For which general area?

Speech development

Language development

Classroom performance

Not sure yet

Briefly tell us what information you're looking for.

4A few things to know

Please confirm:

I understand I'll be contacted and will have 5 days to complete and submit the requested intake.

Please confirm:

I understand that if I don't submit my child's online intake in time, the link can't be resent, and the only way to proceed is to print and mail the PDF intake to Atlanta Speech Therapy's Alpharetta office.

We require a $35 appointment deposit to schedule. This charge is captured after submitting your intake. When you appear at your scheduled appointment, this amount is either refunded or applied to your visit's out-of-pocket costs. This helps ensure clients are considerate of the time we spend preparing for their appointment.

Let's get started

You're in the right place.

Tell us a little about your family

5 things to check before hiring your evaluator

Screen your toddler’s communication now