Let’s Connect.

We are accepting new clients.

All new clients must submit a form below. We will try our best to give you a call within 3 business days if we have an opening that matches your listed availability. If you have not heard from us within 2 weeks, it means that our availability does not match at the moment.

Thank you for your understanding.

Name of Client

First Name

Last Name

Client's Date of Birth

YYYY

Client's Age

Primary Contact

First Name

Last Name

Phone #

(###)

###

####

Language(s)

Please list all of the language(s) spoken by child or language(s) used with child.

Your concerns/questions regarding your child's speech and language development and indicate any previous diagnosis:

(Examples: speech clarity / saying first words or using sentences / language expression / following instructions / social skills / reading / spelling / writing / executive functions)

Does your child display any major behavioural issues at home? If yes, please describe.

Ongoing Availability

To help us match your child with a Speech-Language Pathologist (SLP) who can accommodate your schedule, please specify the days of the week and times you are consistently available for therapy. For example, "Mondays and Wednesdays between 2 PM and 5 PM" or "Tuesdays and Thursdays after 6 PM."

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Do you wish to use third party funding? If so, please indicate below:

Extended Health Benefits

Autism Funding

At Home Program Funding

CKNW / Variety Funding

Home School Funding

We will try to connect you with an SLP on our team. In the event that our SLPs do not have availability for ongoing or in-person sessions, please indicate your interest in the following options. Selecting these alternatives can help us provide you with timely and effective care:

I am interested in the option of connecting with a therapist who can provide online therapy sessions for my child if there are no in-person spots at the moment.

I am interested in the option of doing a consultation and a block of therapy (6-10 sessions depending on SLP's availability) if my availability does not match with the SLP's schedules.

Any comments / questions?

Let’s Connect.

See you at Speech Meta.

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Speech Meta Therapy Services Inc.