Please note these are initial forms to fill out for Kelly Jenkins MHS, CCC-SLP/L.  Please submit these to SLP however you choose prior to appointment, therefore insurance benefits can be checked by Fusion.  We will also need a front and back copy of your insurance card for file & for appropriate contact information.  Please feel free to ask questions. 

SLP will have questionnaire(s) for you to fill out in addition to the 3 forms illustrated above. Please let me know how you would like to receive the questionnaire. If you would like to receive these documents listed here in a different manner (e.g., fax, email with your consent, etc.), please advise. 

If you have a feeding-swallowing-chewing-oral motor, voice, stuttering, memory, processing issue, SLP will have more customized forms for you to fill out to get more specific.  Please keep in mind the initial questionnaire given to you will be broad based covering a wide range of areas/ages to narrow down your concern.  Subsequently SLP may or may not give some more specific/detailed/customized questionnaires and or checklists to further differentiate the concerns.