Individual Speech and Language Therapy

Social Skills for Children Ages 2-16

Your Name

First Name

Last Name

Phone

(###)

###

####

Child's Full Name

First Name

Last Name

Child's Date of Birth

YYYY

Address or general vicinity in which the child lives

Child's School

Reason for referral

Please describe (in detail) any behavioral concerns:

** If your child demonstrates physical aggression and/or challenges with impulse control/self-regulation, please describe (in detail) what this looks like, so that we can make the most appropriate recommendation for your child. If none, please write "none":

How did you hear about us?

Individual Speech and Language Therapy

Individual sessions focus on receptive, expressive and/or pragmatic language skills. They can take place at your child’s school, remotely, or at home. The therapist will create an individualized plan to support your child's language!

We can provide you with coded receipts which you can submit to your insurance for potential reimbursement.