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 (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 tell us about your concerns *

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

Preferred service delivery model: *

I am inquiring about services in: *

Montreal
Toronto

Please provide your child's availability for assessment / therapy *

*The more availability you provide the faster we can offer an opening. Weekdays after 4pm and weekends are in high demand, which mean longer wait times.

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. *

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