Speech Intake

Instructions: If you are interested in your child receiving services through Pediatric Speech Lab please complete each form listed below.

Be sure to click on each form title and complete each one to its entirety. If you were instructed to complete a specific form, click on the corresponding form title and complete the fillable PDF.

Please feel free to contact us as 301-885-0033 if you have any issues with this process. Once you’ve completed each form, please scroll down and use the “Additional Paperwork” section to submit any supporting documents such as a referral or Autism Evaluation if it is applicable to you.

Once you have completed this process please call the clinic at the number listed above to confirm our receipt of your intake paperwork. Thank you for your interest!