Forms and Documents
You'll be asked to complete some paperwork prior to your first appointment at the Sheila C. Johnson Center. Please download your required forms and share with our staff when you visit. Call (434) 924-7034 should you need assistance.
- Provider Notice of Privacy Practices ›
- Consent for Services ›
- Case History ›
- Speech Intake Form ›
- Payment Agreement ›
- Payment Policy ›
How to Download and Complete
All documents are fillable Adobe PDF forms that open in a new window and can be saved to your computer and completed for printing or for future reference.
Adobe Acrobat Reader DC is free to download. Click here to install the software on your device.