Client Inquiry for Social Butterfly Inc. Speech & Language Services
Please fill out this form in its entirety to get on our waitlist! AS OF 02/1/23 we have a waitlist for ALL appointments!
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Email *
Communication concern (choose all that apply): *
Your Name: *
Child's name (if child is the client): *
Child's date of birth: *
Best Phone Number *
Best email address *
City and State *
Which service are you interested in *
Availability (check all that apply) *
Has your child (or you) had a current speech-language evaluation in the past six months to one year? *
What are your communication goals and why did you seek out services at Social Butterfly Inc? *
How did you hear about us? *
What are your child's strengths and interests? *
List any prior services (school and/or private clinic) *
We only accept out of pocket pay for services, but can provide you with a monthly superbill if you would like to submit for out of network with your own insurance.

Services are provided at the following fee schedule:

$300  Speech-Language Assessment with formal report and treatment plan (45-60 minutes)

$200 Informal Speech-Language Assessment without formal report, JUST treatment plan (30-45 minutes)

$166   60 minute therapy session (55 minute session, 5 minute notes/parent contact)

$125 45 minute therapy session (40 minute session, 5 minute notes/ parent contact)

$83     30 minute therapy session (25 minute session, 5 minute notes/parent contact)

$125/hr  attendance at IEP meetings and school observations

$125/hr consultations with providers or parents

Please check the boxes below to show us you understand our process! *
A copy of your responses will be emailed to the address you provided.
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