New Patient Forms

Submit the following form to start the process

Pediatric Patient Intake

Notice of Privacy Practices

Notice of Privacy Practices (pdf)

Download

Physician Forms

Download or submit electronically through our portal

***We do NOT take Superior Health Plan***

HMO Authorizations for BEYOND SPEECH THERAPY

Speech Therapy - Provider Brenda Gillar # NPI 1063882033

Occupational Therapy- Provider Dedria Bryan # NPI 1033390984

Fax 888-245-6178

Referral Form (pdf)

Download

Current Patient Forms

Transfer of Care Form No primary Insurance form Release of Medical Records Form Credit Card Authorization Form Annual renewal Hipaa Form Re-evaluation parent input form

Contact Us
Insurance Tips
Need a ride to Therapy?
PHYSICIAN REFERRALS
Parent Support

Beyond Speech Therapy, PLLC

Admin@beyondspeech.care

Main number: 903-309-3816

Clinic Locations

911 Walnut Hill Dr. Longview, Texas 75605

109 Simpson St Gilmer, Texas 75644

804 North Saint Mary St, Carthage, Texas 75633

Fax 888-245-6178

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