Thank you for considering a Lingraphica communication device, also known as a speech-generating device. To begin a free, no-obligation device trial with your client please upload a scan of your client’s face sheet and insurance cards. Please make sure the images or files are legible to ensure fast processing. We also ask that you include a photo or scan of your client’s insurance card(s). If you have any questions, please call us at 866-330-5958.

Uploading Insurance Card(s)

  • The photo or scans of the insurance cards should include both front and back of the cards.
  • Make sure the information is legible otherwise your request will be delayed.
Example Insurance Cards

Uploading a Face Sheet

  • The face sheet should include client demographics, insurance information, and diagnosis information.
  • A scanned document or screen shot of your client’s face sheet is best.
Example Face Sheet

Please ensure all patient information, including insurance information, is legible and accurate. Inaccurate information will result in delays in your request.

Fax number for supporting documentation: 844-357-1905

PLEASE NOTE: If you’ll be working with your client for less than a week, please contact our team at 866-330-5958 to ensure your request is processed quickly.

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Have you previously conducted a Lingraphica device trial?*

SLP Information

Name*
Email*
Please make sure your chosen images are legible to ensure fast processing. Limit 8 separate files.
Drop files here or
Max. file size: 4 GB, Max. files: 8.
    All of Lingraphica's communication devices have the same software. The only difference is size. To learn more about our devices, visit https://lingraphica.com/aac-devices/
    Which accessories would you like to trial? (Choose all that apply)*
    In addition to the standard case and stylus, please select up to 2 (two) accessories from the list below. Select None if you do not wish to trial any accessories.
    How long do you expect to have this patient on caseload?*

    Shipping Information for Trial Device

    Please note: Trial devices must be sent to the speech-language pathologist. A signature is required for delivery of the trial device.

    Questions or Comments

    If you have conducted a trial previously and your shipping address has changed, please note your new address here.