Spanish Funding Forms

The forms listed below have been translated to Spanish and are specifically for the client and /or family to retain for their records. As mentioned previously, we encourage all of our customers to reach out to us with any questions that you may have!

Client Information Form - Spanish

Gathers client information required by funding providers. All information will remain confidential.

Feature Unlock Key Form- Spanish

This form is required to be filled out and signed prior to purchasing a Feature Unlock Key. The Feature Unlock Key allows users who have dedicated speech generating devices to access capabilities of their device that extend beyond voice output, emailing, texting or making phone calls as required by CMS.

Release of Information (ROI) and Assignment of Benefits Form (AOB) - Spanish
Your signature on this form authorizes Forbes Rehab Services, Inc. to release medical information to your insurance companies and to obtain prior authorizations and payment from your insurance company for services and equipment.

Returns - Spanish
To Return a device, please use this Spanish version form.