Contact

top of page

Use tab to navigate through the menu items.

Please complete the form below to be put on the waitlist for services.
-or-
email Confident Kids Speech Therapy directly.

Please reach out with any referral inquiries!

Self-referrals (i.e. without a doctor's referral) are accepted.

Therapy/assessment availability is subject to referral type and/or current caseload constraints.

Your name

Phone number

Child's birthdate

Has this child received previous SLP support?

Please check the box(es) for the general areas of communication that you are hoping to address in therapy.

SPEECH SOUNDS (the sounds we make)

EXPRESSIVE LANGUAGE (the words we use)

RECEPTIVE LANGUAGE (the words we understand)

SOCIAL/PRAGMATIC LANGUAGE (how we communicate)

FLUENCY/STUTTERING (speech fluency)

AAC (alternative

Other (please discuss below)

Please write a brief inquiry message

How did you hear about us?

Day(s) available for therapy (please check all tht apply)

MONDAY - Morning (8am-12pm)

MONDAY - Early afternoon (12pm-3pm)

MONDAY - After school (after 3pm)

TUESDAY - Morning (8am-12pm)

TUESDAY - Early afternoon (12pm-3pm)

TUESDAY - After school (after 3pm)

WEDNESDAY - Morning (8am-12pm)

WEDNESDAY - Early afternoon (12pm-3pm)

WEDNESDAY - After school (after 3pm)

FRIDAY - Morning (8am-12pm)

FRIDAY - Early afternoon (12pm-3pm)

FRIDAY - After school (after 3pm)

bottom of page