Beyond Speech Therapy Learning

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Free Articulation Screening


Child's First Name: *
Child's Last Name: *
Email Address: *
Address: *
City: *
State: *
Country: *
Zip: *
Phone: *
Child's Age: *

Is your child currently receiving speech therapy?
	Yes No
Has your child received speech therapy in the past?
	Yes No
Does your child have a history of ear infections?
	Yes No
Have you had your child's hearing tested?
	Yes No
When was the last time you had your child's hearing tested?
	Yes No
Does your child have a hearing loss?
	Yes No

* All fields required Note: We are unable to provide free screenings for children who live in Delaware, Georgia, Iowa, Ohio, Oklahoma and Wyoming due to state licensure requirements. By submitting this form I am consenting to allow Beyond Speech Therapy Learning Direct to screen my child for articulation errors. I understand that my child will be asked to repeat a list of words and that the screening will take about 10 minutes. I acknowledge that this is just a screening and that my child may need further evaluation.

No part of the website may be reproduced in any form without the written permisson from
Beyond Speech Therapy Learning, LLC.