A Guide for Parents

If you feel that your child may benefit from our services, please contact the office at (405) 433-4224 or follow the following steps:

Complete the New Patient Information Form
Complete the Case History Form
Please review and accept the Notice of Privacy Practices Consent form

If your child is covered through Soonercare/Medicaid, these additional forms are needed:

Complete the Parental Consent Form.
Complete the Change of Provider Request Form.
A prescription for services and current clinic note completed by the child’s primary care physician. These can be faxed directly to the office at (405) 493-0717.
A copy of the child’s Medicaid card.
A copy of the child’s Individual Family Services/Support Plan (IFSP) or Individual Education Plan (IEP), if applicable.

Attention Practitioners

If you are a physician or health care provider wanting to refer your patient for services, please complete the online referral form. If you prefer, you can also download and complete the ENT Referral Form and fax it to (405) 493-0717.

Download Forms

If you would prefer to download and submit or bring in your forms, please select from the forms below.

Authorization For Treatment

Case History

Change of Provider Request

New Patient Information

Parental Consent

Privacy Notice

Once completed you can fax all forms to the office at (405) 493-0717.

Preparing For Your Evaluation

Once your paperwork has been submitted and reviewed, our office will contact you to schedule an evaluation.

Please allow approximately one to two hours for the evaluation and make sure that your child is well rested and fed. Also, feel free to bring a favorite toy or other item to the session as this may help the therapist motivate and calm your child.

After the evaluation, a report will be written given the findings of the evaluation and recommendations. If you would like us to send a copy to anybody else, please specify during your evaluation.

If treatment is indicated a Consent for Treatment and Cancellation Policy must be completed. Therapy times will be scheduled based on times convenient for you and the availability of the therapist.

Pricing and Payments

In order to make sure services are available to patients who lack health insurance, we offer services at the following prices.

Evaluation

$300

Therapy

$80

Consultation

$80

Screening

$30

Payment for the evaluation and treatment sessions are due at each session if you are solely paying privately.
If your child has Soonercare, no payment is required.
If your child has insurance and we are in-network, we will let you know if you have a co-pay or you have not met your deductible yet. This will be the same for insurance companies in which we are out-of-network.

Insurance

Pediatric Communication Solutions, Inc. is in-network with the following insurance carriers.

Additional carriers coming soon. If you do not see your carrier, contact us to check on its status.

Patient Information