To schedule an appointment in our office…

Please complete these forms. FYI once you start completing forms won’t be saved if you stop before the end and click submit.

Case History (Child)

Case History (Spanish Edition)

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.

*If a child demonstrates limited attention or engagement during the evaluation, our clinician may recommend delaying therapy until readiness skills are established.

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