Case History Forms
Complete the appropriate case history forms online -OR- print and email, fax or mail the form:
PO Box 34
Victoria, MN 55386
Your case history and any other requested information must be received no later than one week before your scheduled appointment.
Steps to Initiating Therapy Service
1) Contact Insurance
Contact your insurance company. Complete the Medical Insurance Benefits Worksheet while talking with your insurance company.
2) Obtain Referral
Obtain order/referral from your child’s physician if you haven’t already. Your physician can send us an order/referral via fax at 952-443-9804
3) Schedule Appointment
Call Kid Talk at 952-443-9888 to set up an appointment.
4) Complete Forms
Complete the appropriate case history form. Your case history and any other requested information must be received no later than one week before your scheduled appointment.
Forms due no later than one week before appointment:
- General Case History Form
- Case History Feeding and Swallowing
- Feeding and Orofacial Myology Case History
- Stuttering Case History
- 5-Day Diet
- Food Inventory Checklist
Forms due at the time of your evaluation:
Forms or files emailed to us will traverse public networks. We are not liable for any interception that may occur with an email transmission.