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Prior to completing New Patient Forms, please review our Billing & Policies section under the Patients tab.

After review, please complete all necessary forms before your first appointment. We cannot provide services unless completed and signed forms are received.

FORM 1

New Patient Intake Form

New to CSS? Be sure to fill out this Intake Form to get started.

FORM 2

New Patient Financial Form

Required for all new patients.

FORM 3

Case History Form

Required for speech/language, feeding, AAC, literacy, and OT evaluations.

FORM 54

Feeding Questionnaire

Required for feeding/swallowing evaluation.

FORM 5

AAC Evaluation Form

Required for AAC evaluation.

FORM 6

AAC Evaluation Vocabulary Questionnaire

Required for AAC evaluation.

FORM 7

Authorization to Discuss Evaluation and Treatment

HIPAA Form

FORM 8

Record Release Authorization

Required to release any information to or from this facility.

FORM 9

Patient Information Update Form

Required for current clients. Please fill out this form if there are any changes to your insurance or contact details.