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Speech Start provides
Pediatric Speech, Language, Feeding, Occupational, Academic
services for individuals ages 0 to 21+
Classes & Programs
Working with Us
About Us
Administrative Staff
Occupational Therapists
Speech-Language Pathologists
News
Resources
Welcome Packet
Summer Group Therapy Form
Mini Summer Group Therapy Form
Credit Card Update
Insurance Update
Waiver
Contact
Classes & Programs
Working with Us
About Us
Administrative Staff
Occupational Therapists
Speech-Language Pathologists
News
Resources
Welcome Packet
Summer Group Therapy Form
Mini Summer Group Therapy Form
Credit Card Update
Insurance Update
Waiver
Contact
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GROUP THERAPY REGISTRATION
Child's Name
(Required)
First
Last
Child's Date of Birth
(Required)
MM slash DD slash YYYY
Child's Age
(Required)
Please enter a number less than or equal to
99
.
Parent/Guardian's Name
(Required)
First
Last
Phone
(Required)
Email
(Required)
Please select the groups you are interested in below
(Required)
Babbling Bunch - $400.00
Playing with Peers 1 - $400.00
Playing with Peers 2 - $400.00
Teamwork Titans - $400.00
Socializing with STEM - $400.00
Social Butterflies - $400.00
Young Adult Group - $400.00
Total
Please note any significant information regarding your child (for example, allergies, potty training, etc.)
(Required)
Please leave your questions, comments, or concerns below. Our office staff will contact you to discuss
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