Thank you for your interest in our clinic's services. We welcome physician, community, and self-referrals, as well as referrals from current clients and their family members. If you know the specific services you, your family member, or your patient is seeking, please select the appropriate registration packet for the services below.
Each application packet provides information about our clinic services. Please fill out the forms as completely as possible in order to provide us with information that will assist us in determining how we may best serve your communication needs. If you have questions about our forms or need more information, please call or email us at 206-543-5440 or email@example.com.
We look forward to receiving your information and coordinating your care,
Julianne Siebens, Clinic Manager
The Application and Intake forms below may be filled out on your computer either within your browser or by using Adobe Acrobat Reader (available for free from Adobe). The form can then be emailed to the clinic at firstname.lastname@example.org, or you can print the completed form and fax or mail it to the clinic. We cannot guarantee that your email communication with us will be secure.
Voice Evaluation Services (must also complete Adult or Pediatric Speech-Language Services application)
Release of Confidential Information (this form is included in the Pediatric and Adult Speech-Language Services applications above)