To schedule an appointment in our office…

Please print, review & complete these forms.

Case History (Child)

Case History (Spanish Edition)

Case History Form -Adult

Credit Card Authorization Form

Once completed, please return the forms to us via email (amy@speechbuilders.org), fax (407-910-2923) or you can drop it off in person.

Be sure to include a referral (if needed)

When we receive your forms, we will process them and one of our therapists will reach out to you to schedule.

If you have any questions about this process please call our office at 407-703-2711.

Call us with any questions you have about these forms: 407-703-2711