• Contact Information
  • Schedule your introductory call
1. Contact Information

Step 1 of 2

First, let’s get some basic details of who is making this request, so we can get in touch for your introductory phone call.

Are you seeking services for you or someone else?
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State of Residence Due to regulatory limitations, we are unable to provide services to clients currently located outside the United States.

What issues or concerns are impacting your speech or ability to communicate?

Do you have health insurance?

What is the name of your insurance provider?

Please provide your Member ID:

Please include your Zip Code:

Please include the Provider Phone Number:

Include the “Providers” phone number from the back of your card.

Does your health plan include out-of-network benefits?

Upload front of the insurance card:
Upload back of the insurance card:

Uploading your card helps us correctly confirm your insurance information before we speak with you.

Thanks for sharing all your info! Let’s schedule your introductory phone call.


On average, speech therapy is about $130 per week. Are you able to invest that amount? (We do accept HSA and FSA.)

2. Schedule a call

Step 2 of 2

Schedule Our Introductory Phone Call

Now to schedule a short introductory call where we can get to know you even better.

Choose a day and time that works best for you to chat with a team member:

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      We have received your complimentary consultation form, scheduled on ***. A Great Speech team member will review the completed form on a phone conference with you prior to your scheduled online consultation.

      Your online complimentary consultation will be administered via secure video conference and can be accessed from any laptop or computer with microphone and webcam capabilities.

      A plan of care and payment options will be discussed during your call.

      Sincerely,

      The Great Speech Team

      Tailored, effective, convenient speech therapy that fits around your life.

      How did you hear about us?

      For assistance completing this form, please call us at +1-954-820-7400 between 8am and 6pm EST.