Beyond Speech Therapy
Beyond Speech Therapy
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    • Home
    • Services
    • New Patient
    • Forms
    • School Contracts
    • español
      • Bienvenido
      • Servicios
      • Formularios
      • Contacto
  • Home
  • Services
  • New Patient
  • Forms
  • School Contracts
  • español
    • Bienvenido
    • Servicios
    • Formularios
    • Contacto

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

Referral Form (pdf)

Download

Current Patient Forms

Transfer of Care FormNo primary Insurance formRelease of Medical Records FormCredit Card Authorization FormAnnual renewal Hipaa FormRe-evaluation parent input form
  • Contact Us
  • Need a ride to Therapy?
  • PHYSICIAN REFERRALS
  • Insurance Tips
  • Parent Support

Beyond Speech Therapy, PLLC

Admin@beyondseech.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


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