Consulting Form for Parents

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I am here to help you make an informed decision about your child's therapy needs. By asking questions, you are not obligating yourself to use me as your therapist. It's like getting a second professional opinion.
My services may be a good fit for your child, but we won't know unless you ask a few questions.

Please list your name, phone number, city, and email so I can reach you. *

List 1. name, 2. phone number, 3. email, 4. child's age (or self) getting service.

State your main question *

e.g. Do you help kids that stutter? or do you help kids with Apraxia, so on

I would like to know about your program *

Please check all that you would like answered

Type of therapy for my child

Availablity, is there a wait list?

Costs involved

Time amount per session?

Expected results time frame

Suggestions to try at home

Summer Intensive Speech Program

SmartPalate, what is this?

Recommendations for other therapists near me?

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