Laurie Nix, M.Ed., CCC/SLP
 (903) 436-4300  |   (903) 868-2330  |    e-mail
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Our Forms

For your convenience, we've provided our forms as print-ready PDF documents. Just print them out, and you can fill 'em out right at home. 

We ask that you have all paperwork with you when you visit us. Thank you.

Note: Forms are also available in our office. These printable PDFs are simply a convenience for you.

Thumbnail Title Description Date Size Type Download
HIPAA Notice of Privacy Practices HIPAA Notice of Privacy Practices We are required by law to give you a copy of our Notice of Privacy Practices. This is our Notice. Please read over it carefully. 03/31/14163.09 KBPDF
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Acknowledgement of Receipt of Notice of Privacy Practices Acknowledgement of Receipt of Notice of Privacy Practices After reading our Notice of Privacy Practices, please fill out this form and sign it. Your signing this form confirms you have received a copy of your rights. 03/31/14103.10 KBPDF
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Consent to Release Information Consent to Release Information Please fill out, sign, date, and return this form, which lets us know to whom (if anyone) you wish us to disclose your child's Protected Health Information (PHI). Conversely, if you wish to not sign at all, simply return the blank form with the rest of your paperwork. 03/31/14149.97 KBPDF
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Patient History Patient History Please fill out this form regarding your child's history in various areas. 03/31/14176.95 KBPDF
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Patient Information Patient Information Please fill out this form with your child's information. 03/31/14147.04 KBPDF
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