Covid-19 Questionnaire Form

 Prior to your child's in person visit, please fill out the online Covid-19 form:

 

New Patients: Forms for your first visit

 

Prior to your child’s evaluation or first session, please complete the Case History form and have it available for the evaluation. You can download and print the completed form and bring it with you to the first session.

 

You can also email forms to us. Emailing forms ahead of time allows us to review all past history and parent concerns prior to the first evaluation/session.  This enables us to get a more accurate sense of your child’s needs before we meet him/her. You can email the completed form as an attachment to gerespeech@gmail.com.

 

We would also appreciate a copy of any prior evaluation reports that can help us better diagnosis your child. These reports can be sent in an email as well.

 

  • Case History Form

 

 

 

 

Other Important Forms:

 

  • Notice of Privacy Practices (HIPPA)

 

 

 

  • Parents Signature Form (HIPPA)

 

 


 

 

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