Office Forms

ROBYN MERKEL-WALSH M.A., CCC-SLP, COM®

Office Forms

Only fill out forms if you have been instructed to do so.

Office Forms

IMPORTANT: Please see the Office Forms below. ONLY FILL OUT THE FORMS BELOW IF YOU HAVE BEEN INSTRUCTED TO DO SO.

Evaluation Forms

If you have been notified that you need to fill out evaluation forms, please download and fill out the forms below based on the age of the patient. Return by mail only. (Infection control document is for your records only.)

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Evaluation Procedures — REVIEW THIS FIRST

Please read before filling out any other evaluation forms.

Download
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Pediatric Case History Form

For patients 17 and under.

Download
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Adult Case History Form

For patients 18 and older.

Download
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Evaluation Contract

Required for all new evaluations.

Download
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Infection Control Policy

For your records — no need to return.

Download
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Notice of Privacy Practices

HIPAA privacy notice.

Download

Therapy Forms

If you have been notified that you need to fill out therapy forms, please download and fill out the forms below.

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Notice of Privacy Practices

HIPAA privacy notice.

Download
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Diamond MYO Office Policies

Full office policies for Diamond MYO & Vocology practice.

Download
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Infection Control Policy

For your records.

Download