Health Science AAC-SGD - 24 Years of Excellence

Company E-mail:
healthscience@comcast.net

Health Science
418 Wall Street
Princeton, NJ 08540

Tel: 800-841-8923
Tel: 609-924-7616
Fax: 609-924-0793

Medicaid :

For insurance cases send directly to:

Health Science

418 Wall Street

Princeton, NJ 08540

1. Completed Patient Information Form
   Patient Information Form
   
   
2. Front and back copy of all insurance cards
   
   
3. Speech Report following Medicare guidelines and any special Medicaid requirements
   SLP Sample Reports
   
   
4. Physician's Prescription (Original; copy or fax is unacceptable)
   Speech Generating Device DME Prescription
   
   
5. Certificate of Medical Necessity from physician(original)
   Certificate of Medical Necessity
   
   
6. Assignment of Benefits Form with Provider Notice of Privacy Practices. This is to be signed by recipient
   Assignment of Benefits Form with Provider Notice of Privacy Practices
   
   
7. Co-pay and deductible if there are plan limitations.
   

Downloadable Forms can be completed and printed: