Contact Us

For general inquiries, please email: info@virtualspeechtherapy.ca

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New Client Registration

Please fill out and submit the form below to express interest in our services. We will get back to you as soon as we can with more information about scheduling, our fees, and the payment process.

Parent/Caregiver Name:

First Name

Last Name

Phone Number:

(###)

###

####

Email

Client Name:

First Name

Last Name

Date of Birth:

MM

DD

YYYY

Home Address:

Please include your street name, city, and province.

Language(s) Spoken:

Preferred Language for Speech Therapy:

Relevant Medical History:

Reason(s) for Concern:

General Weekly Availability:

Contact Us

New Client Registration

Speech therapy wherever you are.

Speech therapy wherever you are.