{"id":602,"date":"2016-08-24T13:20:12","date_gmt":"2016-08-24T13:20:12","guid":{"rendered":"http:\/\/www.hsfeedingandspeech.com\/?page_id=602"},"modified":"2024-01-12T01:20:22","modified_gmt":"2024-01-12T01:20:22","slug":"forms-2","status":"publish","type":"page","link":"https:\/\/www.hsfeedingandspeech.com\/?page_id=602","title":{"rendered":"Forms"},"content":{"rendered":"<div id='av_section_1' class='avia-section main_color avia-section-small avia-no-shadow av-section-color-overlay-active avia-bg-style-fixed  avia-builder-el-0  el_before_av_section  avia-builder-el-first   av-minimum-height av-minimum-height-custom  container_wrap sidebar_right' style='background-repeat: no-repeat; background-image: url(https:\/\/www.hsfeedingandspeech.com\/wp-content\/uploads\/2016\/08\/kids-1500x630.jpg);background-attachment: fixed; background-position: top center;  '  data-section-bg-repeat='no-repeat'><div class='av-section-color-overlay-wrap'><div class='av-section-color-overlay' style='opacity: 0.3; background-color: #000000; '><\/div><div class='container' style='height:200px'><main  role=\"main\" itemprop=\"mainContentOfPage\"  class='template-page content  av-content-small alpha units'><div class='post-entry post-entry-type-page post-entry-602'><div class='entry-content-wrapper clearfix'>\n<div style='height:5px' class='hr hr-invisible   avia-builder-el-1  el_before_av_heading  avia-builder-el-first '><span class='hr-inner ' ><span class='hr-inner-style'><\/span><\/span><\/div>\n<div style='padding-bottom:0px; color:#ffffff;font-size:50px;' class='av-special-heading av-special-heading-h3 custom-color-heading blockquote modern-quote modern-centered  avia-builder-el-2  el_after_av_hr  el_before_av_hr  av-inherit-size '><h3 class='av-special-heading-tag '  itemprop=\"headline\"  >New Patient Forms<\/h3><div class ='av-subheading av-subheading_below av_custom_color ' style='font-size:20px;'><p>Please print and fill out before your first appointment.<\/p>\n<\/div><div class='special-heading-border'><div class='special-heading-inner-border' style='border-color:#ffffff'><\/div><\/div><\/div>\n<div style=' margin-top:20px; margin-bottom:40px;'  class='hr hr-custom hr-center hr-icon-yes   avia-builder-el-3  el_after_av_heading  avia-builder-el-last '><span class='hr-inner   inner-border-av-border-thin' style=' width:20%; border-color:rgba(255,255,255,0.76);' ><span class='hr-inner-style'><\/span><\/span><span class='av-seperator-icon' style='color:#ffffff;' aria-hidden='true' data-av_icon='\ue8bf' data-av_iconfont='entypo-fontello'><\/span><span class='hr-inner   inner-border-av-border-thin' style=' width:20%; border-color:rgba(255,255,255,0.76);' ><span class='hr-inner-style'><\/span><\/span><\/div>\n\n<\/div><\/div><\/main><!-- close content main element --><\/div><\/div><\/div><div id='av_section_2' class='avia-section main_color avia-section-small avia-no-border-styling avia-bg-style-fixed  avia-builder-el-4  el_after_av_section  avia-builder-el-last   container_wrap sidebar_right' style=' '  ><div class='container' ><div class='template-page content  av-content-small alpha units'><div class='post-entry post-entry-type-page post-entry-602'><div class='entry-content-wrapper clearfix'>\n<div class='flex_column_table av-equal-height-column-flextable -flextable' style='margin-top:-60px; margin-bottom:0px; '><div class=\"flex_column av_two_third  no_margin flex_column_table_cell av-equal-height-column av-align-top first  avia-builder-el-5  el_before_av_one_third  avia-builder-el-first  \" style='padding:30px; background-color:#ffffff; border-radius:0px; '><p><div style='padding-bottom:0px; ' class='av-special-heading av-special-heading-h2  blockquote modern-quote  avia-builder-el-6  el_before_av_hr  avia-builder-el-first   '><h2 class='av-special-heading-tag '  itemprop=\"headline\"  >New Patient Forms<\/h2><div class='special-heading-border'><div class='special-heading-inner-border' ><\/div><\/div><\/div><br \/>\n<div style=' margin-top:20px; margin-bottom:20px;'  class='hr hr-custom hr-center hr-icon-yes   avia-builder-el-7  el_after_av_heading  el_before_av_textblock '><span class='hr-inner   inner-border-av-border-thin' style=' width:45%;' ><span class='hr-inner-style'><\/span><\/span><span class='av-seperator-icon'  aria-hidden='true' data-av_icon='\ue8bf' data-av_iconfont='entypo-fontello'><\/span><span class='hr-inner   inner-border-av-border-thin' style=' width:45%;' ><span class='hr-inner-style'><\/span><\/span><\/div><br \/>\n<section class=\"av_textblock_section \"  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock  '   itemprop=\"text\" ><p>To help your first visit go smoothly, we have provided\u00a0a few documents to gather some important information prior to your child&#8217;s appointment. Please print and fill out these forms and bring them to your child&#8217;s first appointment.<\/p>\n<p>If you have any questions, don&#8217;t hesitate to contact us!<\/p>\n<h4>Forms for All Patients<\/h4>\n<ul>\n<li><a href=\"https:\/\/www.hsfeedingandspeech.com\/wp-content\/uploads\/2024\/01\/Policies-and-Procedures.pdf\" target=\"_blank\" rel=\"noopener\">Holly Springs Feeding and Speech Policies and Procedures<\/a><\/li>\n<li><a href=\"https:\/\/www.hsfeedingandspeech.com\/wp-content\/uploads\/2024\/01\/HIPAA.pdf\" target=\"_blank\" rel=\"noopener\">HIPPA Acknowledgement<\/a><\/li>\n<li><a href=\"https:\/\/www.hsfeedingandspeech.com\/wp-content\/uploads\/2024\/01\/Consent-Release-Of-information.pdf\" target=\"_blank\" rel=\"noopener\">Consent and Release of Information Form<\/a><\/li>\n<li><a href=\"https:\/\/www.hsfeedingandspeech.com\/wp-content\/uploads\/2020\/02\/ES-HSFAS-Concent-Release-of-info.pdf\" target=\"_blank\" rel=\"noopener\">Consent and Release of Information Form<\/a> (Spanish)<\/li>\n<li><a href=\"https:\/\/www.hsfeedingandspeech.com\/wp-content\/uploads\/2024\/01\/Attendance-Policy.pdf\" target=\"_blank\" rel=\"noopener\">Attendance Policy<\/a><\/li>\n<li><a href=\"https:\/\/www.hsfeedingandspeech.com\/wp-content\/uploads\/2024\/01\/Sick-Policy.pdf\" target=\"_blank\" rel=\"noopener\">Sick Policy<\/a><\/li>\n<\/ul>\n<h4>Feeding and Swallowing Patients<\/h4>\n<ul>\n<li><a href=\"https:\/\/www.hsfeedingandspeech.com\/wp-content\/uploads\/2024\/01\/Breast-And-Bottle-feeding-Intake.pdf\" target=\"_blank\" rel=\"noopener\">Breast and Bottle Feeding Intake Form<\/a><\/li>\n<li><a href=\"https:\/\/www.hsfeedingandspeech.com\/wp-content\/uploads\/2024\/01\/Pediatric-Feeding-Intake.pdf\" target=\"_blank\" rel=\"noopener\">Pediatric Feeding Intake Form<\/a><\/li>\n<li><a href=\"https:\/\/www.hsfeedingandspeech.com\/wp-content\/uploads\/2024\/01\/Adolescent-Feeding-Intake.pdf\" target=\"_blank\" rel=\"noopener\">Adolescent Feeding Intake Form<\/a><\/li>\n<li><a href=\"https:\/\/www.hsfeedingandspeech.com\/wp-content\/uploads\/2020\/02\/ES-HSFAS-Feeding-Intake-Form.pdf\" target=\"_blank\" rel=\"noopener\">Feeding and Swallowing Intake Form<\/a> (Spanish)<\/li>\n<li>For your first appointment please bring your child hungry but not starving . Please bring at least two to three \u00a0foods that your child will eat and two to three items that they have refused or have been struggling with at home.<\/li>\n<li>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 \u00a0in order to mirror the feeding scenario from home.<\/li>\n<\/ul>\n<h4>Speech and Language\u00a0Patients<\/h4>\n<ul>\n<li><a href=\"https:\/\/www.hsfeedingandspeech.com\/wp-content\/uploads\/2024\/01\/Speech-Intake.pdf\" target=\"_blank\" rel=\"noopener\">Speech and Language\u00a0Intake Form<\/a><\/li>\n<li>\n<p class=\"p1\"><span class=\"s1\">Please bring with you any previous \u00a0speech and language assessments, IFSP or IEP paperwork to your first appointment.<\/span><\/p>\n<\/li>\n<\/ul>\n<\/div><\/section><\/p><\/div><div class=\"flex_column av_one_third  no_margin flex_column_table_cell av-equal-height-column av-align-top   avia-builder-el-9  el_after_av_two_third  avia-builder-el-last  \" style='padding:30px; background-color:#f0f0f0; border-radius:0px; '><div class='avia-image-container avia_animated_image avia_animate_when_almost_visible pop-up av-styling-    avia-builder-el-10  avia-builder-el-no-sibling  avia-align-center '  itemprop=\"image\" itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/ImageObject\"  ><div class='avia-image-container-inner'><div class='avia-image-overlay-wrap'><img class='avia_image' src='https:\/\/www.hsfeedingandspeech.com\/wp-content\/uploads\/2016\/08\/IMG_0901-1-773x1030.jpg' alt='' title='IMG_0901' height=\"1030\" width=\"773\"  itemprop=\"thumbnailUrl\"  \/><\/div><\/div><\/div><\/div><\/div><!--close column table wrapper. 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