Client Resources

New Client Forms

Confirmed new therapy clients must download and complete the below intake forms at least 48 hours prior to the first scheduled session. Completed forms can be emailed to hello@mindgrovegrow.com.

  1. SLP Services Informed Consent

  2. Pediatric Client Intake Form or Adult Client Intake Form

  3. Attendance and Cancellation Policy

  4. Payment Policy

  5. HIPAA Notice of Private Practices (review only)

  6. Acknowledgment of HIPAA Practices

  7. Authorization for the Exchange or Release of Information (complete if consenting to exchange info. with another entity)

  8. Non Medi-Cal Provider Consent

  9. Financial Responsibility Agreement (complete if someone other than the client/guardian will be paying for services)

If you or your child are feeling curious about Hanna before the first session, you can download Hanna’s “Let’s Meet” booklet HERE!

Scene of a peaceful forest with tall trees, sunlight filtering through the branches, a wooden fence along a trail next to a calm pond, and lush greenery.

Superbill Request Form