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    • About ASLS
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  • Start Here
    • Start Here
    • Does My Child Need Help?
    • Does My Adolescent Need Help?
  • Services
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    • Resources
    • Activities
    • Resources for Androids, iPhones, and iPads
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You can contact us at any of our locations to set up an initial evaluation. We are a provider for many health insurance programs, but it is essential that you check your own policy to determine if a doctor’s order is needed and what your individual policy covers. For your convenience, we will submit your claims to the insurance company. A current copy of your insurance cards is essential to maintain timely and accurate communication with the insurance company about your claims. All co-pays and private payments are due at the time of your visit. We accept cash, check, Visa, Mastercard and Discover Associated Speech & Language Specialists is a provider for most insurance plans.

Forms for Download

  • Patient Information Form
  • Insurance Benefit Worksheet
  • New Patient Case History Form – Adult
  • New Patient Case History Form -Oral Myofunctional
  • New Patient Case History Form – School-Age Children
  • New Patient Case History Form – Young
  • New Patient Case History Form – Young Children Feeding
  • New Patient Case History Form – Young Children Fluency
  • ASLS Financial Policy-2020
  • HIPAA Notice of Privacy Practices
  • Authorization for Release of Information
  • Authorization for Release of Information via Email/Voicemail
  • ASLS Cancellation Policy-2020
  • ASLS Payment Policy-2020
  • ASLS Policies-2020
  • ASLS Teletherapy Consent Form

In order to view and print these forms, you need to be able to view PDF files on your computer. If your computer is unable to open these files, you can download Adobe Acrobat free, here.



© 2005-2022 Associated Speech & Language Specialists, LLC

Speech and language clinics located in the Twin Cities of Minnesota.

Call us in St. Paul, MN (651-225-4558), Shoreview, MN (651-639-0942), Plymouth, MN (763-551-3652), or Maplewood, MN (651-773-3208) to set up an evaluation or therapy appointment.

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