TPE REFERRAL PROGRAM

At True Potential Education, we believe collaboration is key to helping children thrive. If you’re a healthcare provider, therapist, or educator looking to connect families with high-quality speech, language, and dyslexia services, we’d love to work with you.

This referral form helps us understand how best to refer patients to your practice—and how you’d like to refer patients to ours. We offer both in-person and virtual services across Iowa and beyond, and accept most insurance plans.

Together, we can ensure every child gets the support they need.

If you would prefer to print the form - you can click here. And then fax it back to us.

Provider Name(s)

Clinic Name / Address

Clinic Phone

Clinic Fax

Contact Person for Referrals

Is your practice open to new patients?

If yes, please describe the type of patient who would be appropriate referral to you form our clinic.

Are there patient conditions/diagnoses/insurances you’d rather not have referred to you? If yes, please provide enough information so we can determine if a referral is appropriate.

Please list the insurance plans you accept:

Please list the specific referral protocols that should be followed?

Please check the box next to the service(s) you would like information on for referrals to our clinic. We have in person and virtual services, and see patients from Iowa as well as other states. We accept most insurances.

Integrated Speech and Language /Dyslexia Therapy * TPE Specialty

Speech / Evaluations & Therapy

Language Evaluations & Therapy

Childhood Apraxia of Speech Evaluations & Therapy

Language Based Dyslexia Evaluations

Dyslexia Remediation (O/G) Therapy

Stuttering/Fluency Evaluations & Therapy

Social Pragmatic Evaluations & Therapy