New Clients

This page is for new families preparing to begin services. You’ll find intake information, required documents, form links, and office policies all in one place.

Everything you need to get started


We want the process of starting speech therapy to feel clear, supportive, and easy to navigate. Use the information below to complete your forms, prepare for your child’s evaluation, and review important policies before your first visit.


Simple Steps Parent-Friendly Clear Next Steps

What to expect

The first step is usually a speech-language evaluation. After the evaluation, we determine whether therapy is recommended and what the next steps will be based on your child’s needs and insurance requirements.

How to begin services

01

Complete your forms

Fill out the required new client paperwork using the links below so we can prepare for your child’s visit.

02

Gather documents

Have your insurance card, referral or prescription if required, and your child’s latest hearing screening available.

03

Attend the evaluation

Your child’s evaluation helps us understand their communication needs and determine whether therapy is recommended.

Helpful documents before your first visit

Some insurance plans require prior authorization before treatment can begin. If that applies to your plan, we’ll guide you through the next steps after the evaluation.



Insurance card and subscriber information
Referral or prescription, if required by your plan
Copy of your child’s most recent hearing screening
Any recent evaluations completed elsewhere
Questions you’d like to ask during the evaluation

New client forms

Please complete the forms below before your child’s first appointment whenever possible.

Important notes before your first appointment

Referral requirements

Some plans require a prescription, referral, or prior authorization before services can begin. If you are unsure, contact our office and we can help you understand what to request from your child’s pediatrician.

Insurance coverage

Coverage depends on your specific plan. Benefits are not guaranteed until claims are processed, so we always recommend confirming speech therapy coverage, deductibles, and visit limits with your insurance company.

Policies and important information

No-Call / No-Show & Late Cancel Policy

Appointments must be cancelled at least 24 hours in advance. Late cancellations and no-call/no-shows will result in a $25 fee. Three no-call/no-shows may result in dismissal from services.

Late Arrival Policy

Treatment sessions are 30 minutes long. If you arrive late, your child’s session will be shortened. Sessions cannot be extended because our therapists are typically booked back to back.

Behavior Safety Policy

If a child is demonstrating aggressive or self-injurious behaviors such as hitting, biting, scratching, kicking, or head banging, we may need to discharge and refer the family to services that are better aligned with those behavioral needs until the behavior is better managed.

Authorization Waiting Period

Some Medicaid and managed care plans require a waiting period after the evaluation while documents are submitted for authorization. We will contact you as soon as approval is received and treatment can begin.



Questions about insurance or billing? Please contact our office manager Dominique at clesiaspeech.officemanager@gmail.com.