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Speech Language Fun

Services for kids Services for adults

Open a File for Kids

Think your child may need a spoonful of speech, language, and fun?
We’d love to talk with you!

Contact information

Your name This field is required

Phone number (daytime) There should be a phone number Please specify correct phone number

Phone number (evening) There should be a phone number Please specify correct phone number

Your E-mail Invalid email address This field is required

Relationship to client

motherfatherother Please choose one of the options

Client Information

Child’s given name This field is required Child’s family name This field is required

Gender

malefemale Please choose one of the options

Date of birth This field is required

Daycare / School name This field is required Current Grade This field is required

Home address This field is required

City This field is required Postal code This field is required

Language(s) spoken at home This field is required Language(s) spoken elsewhere This field is required

Scheduling Information

Please let us know your preferences and we will do our best to accommodate you

Location

SLF clinicSLF mobile service

Please choose one of the options Neighbourhood This field is required

Availability

Monday - Monday

Morning Afternoon Evening

Tuesday - Tuesday

Morning Afternoon Evening

Wednesday - Wednesday

Morning Afternoon Evening

Thursday - Thursday

Morning Afternoon Evening

Friday - Friday

Morning Afternoon Evening

Sunday - Sunday

Morning Afternoon Evening

Please choose one of the options

or specify days and times when your child would be available for an appointment:

Presenting problem

Is your child difficult to understand when they speak?

YesNo Please choose one of the options

Does your child have difficulty following instructions?

YesNo Please choose one of the options

How would you describe your child's speech or language difficulty? This field is required

Is your child aware of, or frustrated by, any speech or language difficulty? This field is required

Do you or your child's physician have any other health concerns? This field is required

Has your child's hearing been tested? YesNo Please choose one of the options

Has your child had speech therapy or any other services or evaluations? This field is required

Referral Source: How did you hear about us?

Open a File for Kids

Think your child may need a spoonful of speech, language, and fun?We’d love to talk with you!

Contact information

Client Information

Scheduling Information

Please let us know your preferences and we will do our best to accommodate you

Presenting problem

Think your child may need a spoonful of speech, language, and fun?
We’d love to talk with you!