Book an Appointment

Appointment Type: *

Please indicate your preference.

Speech Therapy (In-person)

Speech Therapy (Telehealth)

Speech Therapy (In School)

Occupational Therapy (In-person)

Occupational Therapy (Telehealth)

Parent Name *

First Name

Last Name

Child Name *

First Name

Last Name

Child’s Date of Birth *

MM

DD

YYYY

My concern is related to: *

Please select all those that are relevant to your child.

Speech development (pronunciation of sounds)

Fluency/Stuttering (repeating sounds, words, phrases, getting stuck on words)

Vocal quality (unusual voice quality, too high/low, hoarse)

Expressive language development (e.g. amount of words, use of grammar, formulating sentences, retelling events)

Receptive language (e.g. following instructions, understanding questions)

Literacy (reading/writing)

Other

Does your child have any behavioural challenges when they are unable to communicate? *

Yes

No

Sometimes

How did you hear about us?

Friend/Family

Instagram

Website

Google

Other

Cancellation Policy *

I have read and accept the Little Lions Cancellation Policy.