Download: Consent for Treatment Form

interSEED N GROW, LLC accepts referrals for all individuals where there is a concern for development. Please do not hesitate to contact us if you have any of the following concerns:

referralsChild does not use words to communicate on time.
• Child does not understand simple directions.
• Child’s speech is difficult to understand.
• Child is stuttering.
• Child’s voice is hoarse or raspy.
• Child is not sitting, crawling or walking on time.
• Child cannot hold or manipulate toys.
• Child cannot hold pencil correctly or has poor handwriting.
• Child cannot dress or feed self appropriately.
• Child is hypersensitive or hyposensistive to the environment.

If you would like to make a referral, the following are the steps we must take before we can schedule the child for the service requested:

Please fill out the referral form below. It is important that all the information be obtained, so please make every effort to complete the form as fully as possible.
• A verification of benefits will be completed to determine if the requested service is covered by the child’s medical insurance.
• The guardian will be contacted regarding the verification of benefits and the cost of the requested services will be to the family. If the guardian continues to desire the requested service, an intake packet will be mailed to the family for completion. The intake packet includes a parent questionnaire, a release of information to send, a release of information to obtain and a written explanation of the insurance benefits. The requested service will be scheduled at that time.
• The child’s physician will then be contacted to obtain a prescription for requested services.
• If there are any obstacles that hinder the intake process, the referral source will be contacted for assistance.

Please contact interSEED N GROW, LLC if you have any additional questions regarding the services we provide. Our business hours are 8:00am until 5:00pm Monday through Friday. If you are unsure if your child would benefit from speech pathology services and would like a free screening, please contact our office for more information.

We are also available to provide speech pathology services on a contractual basis. Please contact our agency for more information.

Referral Form:

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