Fall 2020 Therapy Schedule Request Form
Please complete the schedule request form below! The Fall 2020 session will start on September 8th, 2020. The completed form is due by August 21, 2020!
Speech Start can NOT guarantee that insurances will continue cover individual and/or group therapy services via telepractice in the Fall of 2020. Please check with your insurance company to determine if telepractice services will continue to be covered for your child.
Speech Start will continue to implement COVID-19 safety rules and regulations in the Fall of 2020. Our waiting rooms will continue to be closed to the public. Furthermore, group therapy sessions will be held in person and the number of children in each group will be significantly reduced to ensure safety and health of others!
Contact Speech Start LLC at 732-888-3912 or via email at
with any questions or concerns!
We look forward to providing services to your and your family this Fall!
Locations: Rumson and Hazlet, NJ
Insurances Accepted: Horizon BCBS, United, and Aetna
-Your Speech Start Family
Welcome to Fall 2020!!!
Child's Full Name
Parent/Guardian's Full Name
Parent/Guardian's Phone Number
Number of Weekly Session(s) Requested
8 or more
Duration of Weekly Session(s) Requested
60 minutes (for Out of Pocket Payers Only)
Type of Session(s) Requested
Individual Speech/Language/Feeding Therapy
Group Speech/Language/Feeding/Social Skills Therapy
Individual Academic Instruction/Tutoring
Group Academic Instruction/Tutoring
Day(s) and Time(s) of Session(s) Requested - PLEASE LIST AT LEAST 3
Preferred Platform for Therapy
Combination of Telepractice and In Office
Therapist(s) Requested - PLEASE CHOOSE AT LEAST 2
Would you like us to try to coordinate your child's schedule with Tender Touch (OT), if possible? There is no guarantee that we can make this happen but we will try our best to accommodate you!
My child is not a client of Tender Touch
Any additional notes/comments/questions/concerns
A copy of your responses will be emailed to the address you provided.
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