This form is intended for families seeking services at Childhood Apraxia & Speech Therapy Centre specific to concerns regarding Childhood Apraxia of Speech (CAS), suspected CAS and/or Motor Speech Disorder. If you are not sure this is the correct form for your child, please contact us.
This form will take you approximately 30-45 minutes to complete, and does not need to be completed all at once. You can save your work at the end of each section and come back to it when you have time.
Before you begin we suggest that you compile important information about your child including their developmental milestones, your child’s speech development, and contact information for other professionals involved with your child. It is also recommended that you consider your current goals and concerns about your child’s speech developmental prior to completing this form.
The information you provide in this form is secure and kept confidential. We take the privacy of your personal information very seriously.
The information you provide in this form, especially the information about your child’s speech development, will help us determine the best course of assessment/consultation and treatment for your child and family, and as such, the more thorough and complete you can be, the better. Please take time to ensure you have submitted your form at least 48 hours in advance of your appointment. After you submit this form, you will have access to a few other documents that we ask you to review prior to our appointment. You do not need to print them or bring them with you; we will go through them together. If you have any other documentation regarding your child’s speech development, please bring it with you to your appointment (i.e. assessments from other Speech-Language Pathologists, reports from community partners, etc).
If there are any questions on this form that you are unsure how to answer, we can discuss them further when we meet. There will be time to clarify any necessary information on this form during our assessment/consultation.
We look forward to meeting with you!