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*Before any speech evaluation begins, the following information is
required. Evaluations will NOT be preformed without:
An ORIGINAL prescription/referral for services from your child’s pediatrician for ‘Speech Evaluation & Treatment’ is required before ANY speech evaluation is
rendered, which should include:
1. Child’s Name & D.O.B.
2. Date of the Prescription must be WITHIN 6 mos of date of evaluation.
3. Diagnosis codes for Speech Evaluation and Treatment (Dr. will write on this prescription).
4. Insurance card
5. Audiogram (If Amerigroup is your insurance).