López-Addison Therapy, LLC
SPEECH, LANGUAGE, AND FEEDING THERAPY
TERAPIA DEL HABLA, DEL LANGUAGE Y LA DEGLUCION
504-784-8840
New Patients Forms
Please complete the intake form for the service(s) you are interested in pursuing for your child! In addition, please send the additional documentation needed to our fax at 504-218-5317 or email info@lopez-addison.com We will reach out to you to schedule your child's evaluation once all documentation is received. Thank you!
Credit Card Authorization Form
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Pediatrics Speech Therapy
Please also send a referral for speech therapy from your child's pediatrician
Pediatrics Feeding Therapy
Please also send a referral for speech therapy from your child's pediatrician
Adult Speech Therapy
Please also send a Referral for speech therapy from your primary doctor.
Privacy
This privacy policy sets out how Lopez Addison Therapy, LLC uses and protects any information that you provide. Lopez Addison Therapy, LLC is devoted to ensuring that your privacy is protected. Should we ask you to provide certain information by which you can be identified when accessing your account information, you can be assured that such information will only be used in accordance with this privacy statement. Lopez Addison Therapy, LLC has a firm policy of protecting the confidentiality and security of information that we collect from our clients. We do not share your non‐public personal information with unaffiliated third parties. Information is only shared with your consent except for the specific purposes below, in accordance with all applicable laws. Please read this policy carefully. It gives you important information about how we handle your personal information. Lopez Addison Therapy, LLC reserves the right to change this policy at any time. USE OF INFORMATION - We limit the collection and use of non-public personal information to the minimum we believe is necessary to deliver superior service to you. Correspondences can include advising you about our services and events happening at Lopez Addison Therapy, LLC. WHAT WE COLLECT - We obtain most non‐public personal information directly from you, by telephone or electronically. We may obtain the following information: First name, last name, email address, home address, telephone numbers and insurance information. WHAT WE DO WITH THE INFORMATION WE GATHER - We request this information in order to provide services and so you will be informed of our services and programs.