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Having the most accurate and reliable information is a key component to helping your child's positive development.
For more details, please visit the following websites:
•
www.asha.org
•
www.apraxia-kids.org
•
www.autismspeaks.org
•
Center for Disease Control
•
PA Promise for Children
•
Everyday I Learn... [PDF]
Complete the following form or call our office at
610-951-4330
to make a referral to our clinic.
*
Indicates required fields.
Child's Name:
*
Child's Date of Birth:
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Parent Name:
*
Parent Phone:
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Parent E-mail:
*
Street Address:
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Address (Line 2):
City:
*
State:
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Zip Code:
*
County:
Services requested:
Speech Therapy
Occupational Therapy
Physical Therapy
Feeding Therapy
Social Skills Program
Teacher Services
Behavioral Services
Child's Diagnosis:
Primary Insurance:
Secondary Insurance:
Please input the following verification code: