Free Consultation with Panorama Speech Therapy
Please fill out the following form as completely as you can. I will reply within 2-3 days to schedule a free 15-minute phone or Zoom consultation.

Note: I am a nationally certified speech-language pathologist, licensed in the state of Maine. This is a consultation service only and it is not a full speech and language evaluation. The purpose of this consultation is not to diagnose or treat. This service is intended to answer questions that you may have about supporting your child's communication and/or to discuss your concerns with their speech and language development.

I look forward to connecting with you!

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Email *
What is your child's name? *
What is your name and relationship to the child? *
How old is this child? If under 3, please include years and months old (for ex. two years, two months). *
What are your concerns regarding your child's communication? If no concerns, what is your interest in seeking a consultation? *
Any developmental concerns aside from speech or language? If none, please write "N/A" *
Any history of health issues (e.g., chronic ear infections, surgery, feeding/eating difficulties, health conditions)? If none, please write "N/A" *
Has your child ever had a speech therapy evaluation? *
If so, please explain the reason for the evaluation and month/year when it took place.
Does your child currently receive speech therapy? *
If so, where? How long have they been receiving speech therapy?
Any other concerns you would like to share with me?
What is your phone number? *
What is the best way to reach you to schedule a time? *
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