To help your first visit go smoothly, we have provided a few documents to gather some important information prior to your child’s appointment. Please print and fill out these forms and bring them to your child’s first appointment.

If you have any questions, don’t hesitate to contact us!

Forms for All Patients

• Holly Springs Feeding and Speech Policies and Procedures
• HIPPA Acknowledgement
• Consent and Release of Information Form
• Consent and Release of Information Form (Spanish)
• Attendance Policy
• Sick Policy

Feeding and Swallowing Patients

• Breast and Bottle Feeding Intake Form
• Pediatric Feeding Intake Form
• Adolescent Feeding Intake Form
• Feeding and Swallowing Intake Form (Spanish)
• For your first appointment please bring your child hungry but not starving . Please bring at least two to three  foods that your child will eat and two to three items that they have refused or have been struggling with at home.
• Please bring all bottles and cups that are being used at home as well as any specific utensils that are used. For infants and small babies, feel free to bring along anything that you are using when feeding such as a boppy pillow or blanket  in order to mirror the feeding scenario from home.

Speech and Language Patients

• Speech and Language Intake Form

• Please bring with you any previous  speech and language assessments, IFSP or IEP paperwork to your first appointment.