Interested in Speech Therapy?
Please fill out the form to learn more about your interest in speech therapy. 
Thank you! 
- Gabriela Herrera SLP and Owner of Bilingual Adventures Speech Therapy, PLLC
- Crystal Evan SLP and Owner of Bilingual Adventures Speech Therapy, PLLC
Email *
What is your name? *
Please write down your cell phone number. *
Email Address *
Where are you located? *
What is your child's date of birth? *
Child's name (only if you are comfortable sharing)
Your answer
Has your child had a speech evaluation by a speech-language pathologist within the past 12 months?
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If they have received an evaluation in the past 12 months, do you have the report available for my review?
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Is your child currently receiving Speech Therapy? *
Please briefly describe your concerns for your child's speech and language development. 
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We are currently private pay only. Knowing this, are you comfortable proceeding with considering Bilingual Adventures Speech Therapy, PLLC as your speech therapy provider? Rates will be provided via email or phone call with more details regarding private pay. 

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How did you find us? If someone specific referred you, please write their name. 
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Do you prefer connecting via email or phone call? *
If you prefer connecting via phone call please let us know 2-3 dates and times that work for you. 
Anything else that you would like us to know? *
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