top of page

Medicare Funding Forms

Medicare Funding Forms

These forms are required in addition to the Standard Funding Forms listed below.

Place of Service Form

This form documents the client’s place of service (private residence, skilled nursing facility, etc.)

Face to Face Notes

Medicare requires that the client have a face-to-face examination with their physician no more than 6 months prior to the written order for the speech generating device (SGD). The physician must document that the client was evaluated and/or treated for a condition that supports the SGD. This documentation (chart notes or office visit notes) must be provided along with the written order for the SGD. 

AAC Evaluation Report

Specific statements and information are required for an AAC Evaluation Report to be Medicare compliant. SLPs may write reports in their preferred format, however the template to the right is recommended as it contains all Medicare-required prompts. This downloadable Report is an interactive PDF document.

Contact your local funding specialist

Forbes AAC has a fully staffed funding team ready to assist you. We dedicate associates to specific geographic regions so that you can contact a local expert throughout the funding process.


By dedicating our experts on a regional basis, we provide you with a trusted partner to maximize our clients' likelihood for obtaining funding.


bottom of page