CONTACT

Name of parent *

First

Last

Name of child *

First

Last

Child's age *

Child's date of birth

Email *

Phone *

Preferred Contact Method *

Email
Phone

Area(s) of concern *

Emergent language (any concern ages 0-3 years)
Expressive language (use of words / sentences)
Receptive language (understanding / comprehension)
Speech clarity (articulation / enunciation)
Apraxia of speech / motor speech
Literacy (phonological awareness / reading)
Fluency (stuttering / stammering)
Other

Please describe your concerns *

Has your child been seen by a speech-language pathologist in the past 12 months? *

If you answered yes to the previous question, do you have a speech and language assessment report from these services?

If you have a report, we will ask you to send it for review.

Preferred service delivery model: *

I am inquiring about services in: *

Montreal
Toronto

Please provide your child's availability for services. *

Anytime (9:00am-6:00pm)
Mornings (9:00am-12:00pm)
Early afternoons (1:00pm-3:00pm)
After school (3:00pm-6:00pm)

*The more flexible your availability, the shorter the waiting time. Weekday morning at 9:00am and after 3:00pm are in high demand, which mean longer wait times. Please note we do not offer weekends.

Please select the language you are seeking services in (Montreal only)

Please provide your address if you are interested in home-visits (Toronto only)

I grant permission for SpeakAble to contact me. *

I consent

CONTACT

FACEBOOK