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  • Can we contact you via email? * Required
  • Has the child had any previous speech/language therapy? * Required
  • Is the child receiving speech/language therapy at the present time? * Required
  • Developmental History

  • Did child suck thumb or use pacifier?
  • Has the child ever had a hearing evaluation?
  • Does your child wear glasses?
  • Speech & Language History

  • How does your child usually communicate?
  • Is your child able to understand...
  • School History

Specialized Speech and Language Therapy