Spero Stuttering Caregiver Bridge Complimentary Conversation

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Caregiver Bridge is an on-demand helpline that connects parents and caregivers with allies and specialists in stuttering and cluttering during the early stages of finding therapy and support. Our desire is to make it easier than ever for caretakers to understand their child’s stuttering and find the care they need to feel empowered, encouraged, and heard!

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A complimentary conversation is available for informational and educational purposes only and does NOT constitute a comprehensive speech-language evaluation or treatment. Detailed terms are found at the end of this form.

Caregiver Name *

Today's Date *

YYYY

Email Address

(This is the email address that will be used to supply the Zoom link if you choose a Zoom call.)

Please indicate your preference: *

Zoom video call (15 minutes)

If Zoom call, our availability is on Fridays between 1:00-3:00 PM CST (Central). Please indicate your desired Friday (provide date):

YYYY

If Zoom call, please indicate your desired time based on the date you provided above (please note times shown in Central and Eastern time zones): *

1:00-1:15 PM CST / 2:00-2:15 PM EST

1:15-1:30 PM CST / 2:15-2:30 PM EST

1:30-1:45 PM CST / 2:30-2:45 PM EST

1:45-2:00 PM CST / 2:45-3:00 PM EST

2:00-2:15 PM CST / 3:00-3:15 PM EST

2:15-2:30 PM CST / 3:15-3:30 PM EST

2:30-2:45 PM CST / 3:30-3:45 PM EST

2:45-3:00 PM CST / 3:45-4:00 PM EST

I am requesting an email rather than Zoom call.

If you signed up for a Zoom call, please note you will NOT receive a reminder message regarding this appointment. *

Yes, I have placed the chosen date and time on my calendar.

No, I have not placed the date/time on my calendar (not recommended).

Not applicable

I am the child's: *

Parent or legal guardian

Caregiver other than parent

Other:

Please provide a brief description of why you are reaching out today, including the age of your child and how long your child has been stuttering: *

Have you watched Spero's film, Nurturing and Empowering Your Child Who Stutters? If not, we would highly recommend you watch this 20-minute video: Nurturing and Empowering Your Child Who Stutters *

I have watched Spero's film for caregivers.

I haven't watched Spero's film but plan to do so prior to my complimentary chat.

How did you hear about Caregiver Bridge? *

This complimentary conversation is provided for informational and educational purposes only and does NOT constitute a comprehensive speech-language evaluation or treatment. The consultation:

* Is a preliminary, limited discussion to provide general guidance and insights.
* Cannot diagnose, treat, or definitively address specific communication concerns.
* Should not be considered a substitute for a full, in-person professional assessment by a certified and licensed speech-language pathologist.

By requesting and participating in this call, you acknowledge and agree that:

1. The information shared is general in nature and not fully tailored to individual needs.
2. Any recommendations are preliminary and should not replace professional judgment following a comprehensive evaluation.
3. A comprehensive evaluation is necessary to accurately assess and address communication challenges.

4. The speech-language professional and Spero Stuttering, Inc. are not liable for any decisions, actions, or outcomes resulting from this conversation.

Caregivers are strongly advised to consult with a qualified speech-language pathologist for a thorough, personalized evaluation and professional recommendations specific to their individual needs.

I understand and agree to the statements above.

Electronic Signature *

I acknowledge that entering my name and date on this form serves as my signature.

Submit

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