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The Teaching of Talking 2.0 Survey
Please answer the questions below and submit to us. . We will review it and then contact you about a Get Acquainted and Strategy Call.
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Your Name:
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Your answer
Your Spouse-Family Member Name:
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Your answer
Home Address, City, State, and Zip Code:
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Your answer
Your E-Mail Address:
Your answer
Your Phone Number: (Area Code) + Number
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Your answer
Why did you contact us?
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Your answer
What is it that you want to achieve?
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Your answer
What would happen if you are unable to get the therapy or help for the person with the speaking difficulty?
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Your answer
Are you committed to better speaking?
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Your answer
Are you looking for expert speech therapy-Mentoring and willing to do what it takes to improve talking?
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Your answer
Since we do not accept insurance assignment we provide you with reports and itemized visit records. Client or family is responsible for treatment visits. Would you be able to provide for the cost of therapy?
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Yes
No
I can not afford any individualized care
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