How to Make a Referral/Appointment
A provider may refer a client for services by calling or faxing the clients information.
- Calling 434-395-2972
- Faxing 434-395-2622
What we need:
- Services needed/requested
- Speech-language evaluation
- Hearing evaluation
- ADOS testing
- Client’s demographic information
- Name of the responsible party (if different from the client)
- Name of referring physician/provider
- Primary insurance information
- Secondary insurance information
You may call our office at 434-395-2972 or walk into our clinic and provide this information. Any of this information may be faxed to 434-395-2622.
Most of the services we provide require a written order/referral from the client's primary care provider
We will need:
Basic Client Information
- Date of Birth
- Physical Address (Street Number and Name, City/County, State, zip code)
- Mailing Address (if different from physical address)
- Phone Number
- Emergency contact information (Name, relationship to you i.e. spouse, mother, father, friend.
- Primary/Family doctor
- Referring doctor name
- Primary and secondary insurance provider (s)
Client Health Information
- Allergies (food, medicine, latex)
- Major medical history i.e. surgeries, therapies
You may print and bring your completed registration form packet on the day of your appointment if you choose.
There are 3 different types of form packets:
- Audiology Adult
- Audiology Child
Please call our office if you are unsure of which form packet to complete for your appointment.