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.