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Name of parent
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Name of child
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Last
Child's age
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Child's date of birth
Email
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Phone
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Preferred Contact Method
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Email
Phone
Area(s) of concern
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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
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Has your child been seen by a speech-language pathologist in the past 12 months?
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Yes
No
Preferred service delivery model:
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In-person
Virtual
I'm open to either
I am inquiring about services in:
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Montreal
Toronto
Please provide your child's availability for assessment / therapy
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Anytime (9am-8pm)
Mornings (9am-12pm)
Afternoons (1pm-4pm)
After school (4pm onwards)
Evenings (6pm-8pm)
Anytime except my child's nap (12pm-3pm)
Weekends
*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)
English
French
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Please provide your address if you are interested in home-visits (Toronto only)
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