We appreciate your referral!

Physician Referral Fax Number: (678)784-0820

Information needed for a referral

Thank you for referring your patient to the Georgia Institute of Speech and Language, LLC.

Please fax referral information and case history to (678)784-0820. Documentation must include the following information:

  • Patient Information:

    • Full name of the patient.

    • Date of birth.

    • Contact information (phone number, email address, mailing address).

  • Referring Physician Information:

    • Name of the referring physician.

    • NPI number

    • Contact information for the referring physician, including phone number and address.

  • Prescription: The prescription will need to have an order for a speech-language evaluation (evaluate and treat + 6 months) and a diagnostic code. Some of the most common diagnostic codes typically used for Speech Language Evaluation include:

    • F80.0 Articulation/Phonological Disorder 

    • F80.1 Expressive Language Disorder

    • F80.2 Mixed Receptive-Expressive Language Disorder

    • F80.81. Childhood-onset fluency disorder

    • F80.89 Other developmental disorders of speech and language

    • F80.9 Developmental disorder of speech and language, unspecified

    • F80.4 Speech and Language Developmental Delay due to hearing loss

    Medical History:

    • Relevant medical conditions or diagnoses that may impact speech and language development (e.g., autism spectrum disorder)

    • Any history of developmental delays or speech and language difficulties.

    • Details of any past speech therapy or interventions.

  • Reason for Referral:

    • A clear description of the specific speech or language concerns prompting the referral (e.g., articulation difficulties).

    • Any observable behaviors or symptoms related to speech and language issues.

  • Diagnostic Information:

    • Audiogram

    • Results of relevant assessments or tests related to speech and language abilities.

    • Any relevant medical imaging or diagnostic reports (e.g., MRI, CT scan).

  • Current Medications:

    • List any medications the patient takes, especially those that may impact speech or cognition.

  • Other Relevant Information:

    • Any known allergies or sensitivities.

    • Information about the patient's educational or occupational environment, if relevant to their speech and language needs.

    • Any additional concerns or considerations that may be relevant for the speech therapist.