Fairmount Speech and Swallowing Therapy
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Client Forms 

Intake Forms

Click HERE to fill out a new client form
Click HERE to fill out a client satisfaction survey ​

Leave a Google Review to let us know how we're doing!

Click the on-boarding forms below to sign 

Forms are signed through the HIPPA compliant (safe/secure) version of JotForm
Telepractice Consent

HIPPA Document
Acknowledgement HIPPA

Attendance/Cancellation Policy

Consent to Record Audio/Video
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P: (215) 645-2699
Philadelphia and New Jersey

contact@fairmountspeech.com
@2020 Fairmount Speech and Swallowing Therapy, LLC. All rights reserved.
Disclaimer: Information on this website does not constitute medical or health advice or services. It is intended and my be used, for educational purposes only. 

Fairmount Speech and Swallowing Therapy, LLC provides medical or health advice and services pertaining to the subject of Speech-Language Pathology only through in-person or online therapy.
  • Home
  • Services
    • Therapy Services
    • Speak OUT! Parkinson's Program
    • Online Therapy
  • Client Portal
    • Forms
    • Online Therapy Tips
    • Session Information
  • Contact
  • About
    • About Me
    • Information/Associations
    • Blog