Forms

Please print, fill out and return the following paperwork via fax, email (contact@wordofmouthca.com) or hand delivery to the clinic, prior to your appointment. If paperwork is not completed prior to your appointment, please arrive 15 minutes before your scheduled time to complete it at the clinic. Thank you!

 

Speech Language New Student Paperwork

Occupational Therapy New Student Paperwork

*Blue Cross/Blue Shield Occupational Therapy New Student Paperwork

 

*Our clinic is currently only accepting Blue Cross/Blue Shield insurance for our Occupational Therapy Clients. If you would like to submit to your insurance company independently, we can provide you with the necessary diagnostic/procedure codes.