New Patient Forms

Speech Solutions Hawaii new patient forms are included below. Please fill them all out completely before coming in for your evaluation. If a form does not apply to your situation, we will shred it; it saves valuable time to have them filled out prior to your appointment. If you have any questions, you can email admin@speechsolutionshawaii.com.  We look forward to working with you and seeing how we can partner together in speech!

Agreement of Financial Responsibility

Description of Typical Therapy

Diet Journal

Explanation of Fees

Health History

HIPPA

Home Observation Checklist

Parent Present Policy

Payment Authorization Form

Permission for Exchange of Information

Release and Hold Harmless

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