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The Kids' Communication Center

Providing pediatric speech-language therapy in the DC Metropolitan area

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Speech-Language Screening

Please complete the following form to register your child for a speech-language screening through The Kids' Communication Center.

Name of Child's School

Class or Teacher's Name

Child's First Name

Child's Last Name

Child's Date of Birth

Home Address

E-mail

Phone

Areas of Concern or Reason for Screening

By entering my name below, I authorize The Kids' Communication Center to screen my child and exchange information with the parents and my child's school.

Thanks for submitting!

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Contact us:

202-237-7079

Find us:

4906 Wisconsin Ave., NW

Washington DC 20016

laura@thekidscommunicationcenter.com

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