Speech Therapist

Request an evaluation with Shana

Tell us a little about your family and a few times that work — we'll confirm within one business day.

Your information

Your name*

Phone*

Email*

I agree to the terms and privacy policy.

What brings you here?

What does your child need help with? Pick any that apply.

Please describe in more detail

Where would you like therapy?

Select any that apply — we'll ask for each address.

When are you generally free?

This isn't your appointment time — the more windows you select, the better the chance of finding a time that works for therapy. We'll follow up to lock in the exact day and time.

Mon

Tue

Wed

Thu

Fri

Sat

Sun

Morning8–12

Afternoon12–3

After School3–5

Evening5–8

Payment

How would you like to handle payment?

Your child

We use this to verify benefits under your child's name and start their file.

Child's first name*

Needed to check your insurance under their name.

Child's last name*

Date of birth*

By submitting, you agree Origin Therapy may contact you about scheduling. We never share your information.