Please complete the following form if you are interested in adding your child to the wait list for a speech, language, or feeding evaluation/therapy. Please note the following prior to filling out this form:

The wait list generally has about 15-20 kids on it. Wait times can vary greatly depending on your availability (between 2 weeks to 6+ months). Due to excessive wait times, I am NOT currently taking new referrals for 4pm or later appointment times.
I currently accept the following insurance plans: Premera, Regence, Tricare, Blue Cross/Blue Shield, Aetna, and First Choice.

Parent/ Guardian Name

First Name

Last Name

Phone

(###)

###

####

Child's Name

Date of Birth

YYYY

Brief Description of Concerns

Insurance

Two Bridges can bill the following insurance plans. Please check which plan your child is currently covered by:

Premera

Regence

Tricare

First Choice

Blue Cross/Blue Shield

Aetna

None of the above

Availability

Please give some general information about when you and your child are/aren't available for speech therapy. For PLEASE NOTE: I am not taking new referrals for 4pm or later time spots due to high demand and LONG wait times for these times.

Next Steps

You will receive an email confirming that I have received your form, and have been added to my waitlist. I will email you when your child is nearing the top of my waitlist to gather more information. Please add julie@twobridgesspeech.com to your address book so my response does not end up in your spam/junk folder.

Waitlist