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 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

Looking for new patient paperwork?

Click here

This website uses cookies.

We use cookies to analyze website traffic and optimize your website experience. By accepting our use of cookies, your data will be aggregated with all other user data.