AMP Kentucky, specializes in Sleep, Respiratory, Speech, Mobility, and other healthcare products. Our goal is to assist customers in having the highest quality of life possible!

AAC Referral Form

Click below to download a PDF version of our AAC referral form

Please return via FAX (931) 540-8209 or EMAIL referral@ampkentucky.com

AAC Referral Form + medical consent form

AAC Medical Consent

Click below to download a PDF version of our AAC Medical Consent

Please return via FAX (931) 540-8209 or EMAIL referral@ampkentucky.com

AAC Medical Consent

AAC Evaluation Template

Click the button below to access either the online evaluation or PDF evaluation template

aac evaluation - online form

Please return the PDF TEMPLATE via FAX (931) 540-8209 or EMAIL referral@ampkentucky.com

AAC Evaluation - pdf Template