Patient Information and Consent Form

Thank you for your interest in Synaptic Pediatric Therapies! Our commitment is to ensure your child receives premium speech and occupational therapy with our licensed Speech and Occupational Therapists. We promise to show the same compassion to your child as you would, and commit to help improve his speech and occupational skills. 
Please fill in the following information to the best of your ability, and an administrator will reach out to you to set up an initial evaluation within 24-48 hours. Alternatively, you may call (972) 454-9309 to schedule an evaluation immediately. Mandatory fields are marked with a (*)