Interest Form
Thank you for choosing The Dramatic SLP LLC! 
Please complete this form so we can learn more about you or your family member and determine the best services to meet your needs. 
***Completing this form does not obligate you to begin services***
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Email *
Name *
Location for Services (Ex. East Orlando, Lakeland, Sanford etc.) *
Phone number *
Who is this inquiry regarding?
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Requested Service (s) *
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Please select all days and times that you generally have availability for classes/therapy sessions:
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Evening
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  PREFERED METHOD OF CONTACT    *
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Please select your preferred time to be contacted
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Afternoon
Evening
Monday
Tuesday
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Thursday
Friday
Saturday
IMPORTANT NOTE 
The Dramatic SLP LLC is a private pay only clinic.  
We proudly serve as a Direct Provider for Step Up for Students (when applicable). 
Commercial insurance is not billed; however, Superbills are available upon request for possible out-of-network reimbursement.  
Please provide a description of your concerns or any information you would like to share with us prior to us reaching out. 
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