WELCOME TO DV THERAPY
We are pleased to provide your therapeutic services. It is our goal to provide the most effective and
family-centered treatment as possible. Comments regarding your experience with our practice are always
welcome. This information helps us meet your individual needs and maintain quality services for our
clients.
OUR SERVICES AND FEES
The client is responsible for all payments due at the time of service.
We are in network with a number of insurance companies and government sponsored programs. For any
insurance that DV Therapy is ‘in network’ with, we will bill the insurance company directly. Please note
that if your deductible has not been met, you will be responsible for the full amount at time of service. If
there is a denial from the insurance, you will be responsible for the full payment once we receive the
denial.
For all others, we will bill the client directly, giving the family the opportunity to work with their own
insurance companies to seek reimbursement. We will provide the client with receipts and invoices, which
will list diagnosis and procedure codes as required by insurance companies.
We highly recommend that all families check with their insurance companies to review coverage
details before agreeing to begin therapy with us
We accept the following forms of payment:
-Checks made out to “DV Therapy” - Cash -Credit Cards
DV Therapy Client Service Agreement- 2020 2
Thirty days notice will be given in advance of any fee increases for treatment services.
COMPREHENSIVE INITIAL EVALUATION
Evaluation sessions last 1-1.5 hours.
OT rates
Therapy: $130 for 30 mins
Therapy: $260 for 60 mins
Evaluation: $90 for every 15 minutes
ST rates
Therapy: $75 for 30 mins
Therapy: $150 60 mins
Evaluation: $300 hr
Evaluations include some or all of the following depending on the age and needs of each child:
● Standardized Articulation Assessment
● Oral Motor/Feeding Evaluation
● Phonological Processes Inventory
● Vocabulary Inventory
● Reading Fluency Assessment
● Reading Comprehension Assessment
● Stuttering/Fluency Assessment
● Social Skills Evaluation and Observation
● Parent Questionnaire/Developmental History
● Parent/Teacher Interview
When DV Therapy has not conducted the speech-language evaluation for your child, we REQUIRE that
you provide us with a copy of the outside evaluation report, completed within the last six months, before
we can begin treatment. We cannot ethically begin therapy without an evaluation.
TREATMENT SESSIONS
Sessions are carefully pre-planned for your child. Your child will work directly with the therapist for the
bulk of the session, leaving 10 minutes at the end to talk with the parent and/or write a brief treatment
note. Please be considerate of the therapist's schedule as he/she may have another session following
yours. If you require an extended conversation with your speech therapist, you may schedule a time for a
meeting or phone conference.
Carry-over of treatment goals and progress into your child’s natural environment and routine is critical for
maximum progress. For parents who are not able to participate in sessions, a communication plan should
be determined directly with the therapist at the start of treatment and modified as needed during the
course of treatment. Options include email, notebooks, multi-media messaging, and/or meetings.
When observing/participating in a treatment session, we would appreciate your consideration in the
following:
• Please minimize the amount of distractions during the sessions
• Please be considerate of time constraints by keeping post session conversations short.
TREATMENT RATES
Session lengths may vary from 30 minutes to 2 hours depending on each individual situation, so charges
are based on the set rate; $75 30 minutes and $125 for an hour.
Group sessions are billed according to the length of session and number in the group. Periodically it is necessary to participate in extensive case management activities, such as parent and
school conferences, to assure proper coordination of and communication about services. Therefore,
with parental notification, conferences with parents, teachers, and other professionals, school
observations, and lengthy telephone consultations will be billed at the hourly rate. There is no additional
charge for “routine” case management activities (planning, chart keeping, brief coordination calls).
Supplementary testing and/or re-evaluations, conducted with parental permission, will be billed at the
evaluation rate of $225.
REPORT FEES
Additional reports (other than Annual Treatment Summaries and/or Discharge Reports, which are written
by the SLP) will be billed at the hourly rate. When you or your insurance company REQUEST
ADDITIONAL REPORTS, you will be billed at the hourly rate.
RELEASES OF INFORMATION
We respect your confidentiality in all matters. If you would like us to release information about an
evaluation and/or treatment to another agency or professional, please request our standard Release
Form from the office.
If you would like us to have prior records of your child, which are often very helpful clinically, please have
the information forwarded to our office.
RECORD KEEPING
DV Therapy Speech Services keeps copies of evaluations, re-evaluations, session notes, and discharge
reports for all clients. We provide clients with copies of all formal reports upon request. It is our policy to
keep digital office copies of these formal reports for a period of 5 years after client discharge. After that
time, the records will be removed from our database. You are encouraged to keep and store your own
copies of formal reports for your permanent records.
Speech Therapy: Speech therapy is an intervention service that focuses on improving a child's speech and ability to understand and express language, including nonverbal language. Services will include areas of articulation, stuttering, receptive and expressive language disorders, voice, social skills, auditory processing disorder, and Augmentative/Alternative Communication (AAC)(Required) The recommended treatment areas and service level will be outlined in the Assessment Report provided and explained to you by the clinician. Your permission is needed to implement the assessment recommendations and to further develop treatment plan goals and objects. DV Therapy has my permission to use mine and/or my child’s photograph publicly to promote the office. I understand that the images may be used in websites, print publications, online publications, presentations, and/or social media. I also understand that no royalty fee or other compensation shall become payable to me by reason of such use. I agree with the above statements DV Therapy Inc fosters a learning environment for volunteers and interns to receive observation hours, as well as provide treatment to clients with guidance and supervision by DV Therapy's treating therapists. FAMILY INFORMATION
Child’s Name
First
Last
Parent's Name(Required)
First
Address
Relation to Client(Required)
First