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We have updated our privacy policy   

Commercial insurance only orders must be COMPLETE and received by PRC-Saltillo on or before November 5, 2021. This deadline does not guarantee processing and shipment of the AAC device before December 31. Click here to learn more.



Submit Client Information

Use the form below to submit client information and take the first step in a funding application. Your information will be sent directly to our funding department as well as sent to the SLP you have named in the bottom of this form. The SLP will need to accept the submission in order to view it in their AAC Funding Toolkit account and fulfill next steps like the speech evalutation. Please follow up with them to verify they have received the information.







Enter the diagnosis or ICD-10 code


Enter the diagnosis or ICD-10 code





Medicare funded devices must ship direct to client.
We cannot ship to a P.O. box.

Name and ID number from at least one section must be entered.
Enter the name of the Insurance company and the Client’s ID number exactly as it appears on their medical card(s). A legible picture or copy of both sides of the card(s) must be uploaded with the Funding Request. Failure to provide all insurance coverages will delay the funding request.

Medicare

Medicaid
Insurance

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If the device is less than 5 years old, please explain who purchased the SGD and why it’s unable to meet medical communication needs.

Clinician/SLP Information

Your information will be sent directly to our funding department as well as the Clinician or SLP (speech language pathologist) you have named below.
Please tell us the name and email address of the SLP who should receive this information. Once they accept your submission, they will be able to track your funding application, proceed with the next steps and share progress with you.

Your information will be sent to our funding department ad well as the account linked to the email address provided below.