Waitlist Request
Thank you for your interest in speech and language services. Please note we have a long waiting list at this time. We have recently downsized our practice and only have one full-time provider in San Francisco. We have some part-time providers offering teletherapy. If you think your child is a good candidate for teletherapy, please indicate that on your form below. Teletherapy spots tend to open up more frequently than in-person spots. 

You are welcome to join our wait list for any type of service, but note that wait times will be very long for in-person services. We apologize for the inconvenience. To join the wait list, please answer a few questions to help us get a sense of your family's needs so that we can monitor our schedules for openings that will be a good fit for your child. We are in-network with all Blue Cross and Blue Shield PPO plans.

Please note that we are not actively booking any in-person appointments at this time and will only contact you when we have an opening. 

Thank you! 
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Email *
What is your child's name? *
What is your child's current age? *
What is your child's date of birth?
What is your name? *
What is your phone number? *
What services are you seeking? (check all that apply)
What areas are you concerned about? (check all that apply) *
Required
Has your child had a speech/language evaluation? *
What school and grade does your child attend?  *
Please describe any other evaluations or services your child receives or has received in the past. 
Has your child had any previous speech/language therapy? *
(Optional) Please share any pertinent information about your child's previous speech/language therapy
(Optional) Is there anything else you would like to add about your reason for seeking speech/language help?
How many health insurance plans is your child covered under? *
Which insurance plans cover your child? *
Required
When would you like to get started? *
Please describe your child's general availability (days and times they could attend sessions on a regular basis). *
How would you like us to contact you when we have an opening?  *
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