Printable Forms

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For Our Patients:

New Patient Information Form      For all new insurance/private pay patients

 New Medicaid Patient Information Form      For all new Medicaid patients 

Pediatric Case History Form

Adult Case History Form

Swallowing History Form

PDF Release of Information to CTSPS
When you want to give consent for another individual to share information with us

PDF Release of Information from CTSP
When you want to give consent for us to share information with someone else

PDF Letter of Provider Change
When you want to authorize a Medicaid provider change

For Parents, Teachers, & Physicians:

PDF Communication Screening Tool
Help in determining if your child, student or patient has a communication disorder

For Physicians:

PDF Physician Referral Intake Form
When you would like to refer a patient to CTSPS for evaluation and/or treatment 

 Find us on Facebook - Central Texas Speech

Map South Austin
2525 Wallingwood Drive
Building 2
Austin, TX 78746

Map North Austin
8500 Bluffstone Cove
Building B
Suite 105
Austin, TX 78759

Phone: (512) 327-6179
Fax: (512) 327-1545