Home
Services
Help Me Communicate
Help Me Sign
Orofacial Myofunctional Therapy
Help Me Eat
Help Me Learn
Help Me Play
Resources
Client Resources
Professional Resources
Client Login
Professional Network
Network Registration
About
Contact
More
FAQs
Testimonials
Blog
Submit Patient Details
10260 Baltimore National Pike; Ellicott City, MD 21042
410-442-9791
barbara@helpmespeak.com
Home
Services
Help Me Speak is here to help your family with these services.
Learn more
Help Me Communicate
Help Me Sign
Orofacial Myofunctional Therapy
Help Me Eat
Help Me Learn
Help Me Play
Resources
Explore how Help Me Speak can further support you and your family with ease.
Learn more
Client Resources
Professional Network
Professional Resources
Client Login
Network Registration
About
Contact
More
Keep yourself updated with our latest insights.
Learn more
FAQs
Testimonials
Blog
Get Started
Submit Patient Details
Contact us
Stay Connected With Us
Speech Therapy. Language Therapy. Orofacial Myofunctional Therapy. Sign Language. Reading. Play. Pragmatics.
Contact info
Stay Connected With Us
To get in touch with us, fill out our online form, or utilize one of our other contact options.
Call us
410-442-9791
Mail us
barbara@helpmespeak.com
Office Location
10260 Baltimore National Pike; Ellicott City, MD 21042
Hours of opertaion
Monday - Thursday : 08:30AM-06:30PM
Follow us on social channels
Visit our Facebook
Visit our Instagram
Visit our Twitter
Submit Patient Details
Request an Evaluation!
Contact Form
First Name
Last Name
Email
Phone/Mobile
Type of Insurance
Age of Potential Client
Name of Potential Client
Select ALL days that the client is available.
Monday
Tuesday
Wednesday
Thursday
Select ALL time slots that the client is available.
8am-12pm
12pm-3pm
3pm-6pm
Other (please indicate below)
Other
I agree to receive SMS notifications, alerts, and occasional marketing communications from Help Me Speak. Message frequency may vary. Standard message and data rates may apply. Text HELP to (443)-979-8866 for assistance or reply STOP to unsubscribe at any time.
I consent to have this website store my submitted information so they can respond to my inquiry and I give consent to be contacted via SMS at the phone number submitted. I understand that I will be placed on the waiting list after completion of this form AND the submitted, completed case history & insurance information.
Message
Submit Form
Please download, complete, & return the appropriate forms for client age & insurance:
Pediatric Ins Eval Reservation
Pediatric Medicaid Eval Reservation
Adult Eval Reservation
Submit the appropriate Evaluation Reservation form to secure an evaluation appointment.
Case history is due the week prior to the appointment. Bring these 3 forms & adult's driver's license & client's insurance card to the evaluation appointment:
Pediatric Case History
Pediatric Release Consent
HIPAA Policy
Pediatric Client Policies
Adult Case History
Adult Release Consent
HIPAA Policy
Adult Client Policies
envelope-o
map-marker
calendar
phone
envelope
angle-down
map-marker
cross
arrow-right
linkedin
facebook
pinterest
youtube
rss
twitter
instagram
facebook-blank
rss-blank
linkedin-blank
pinterest
youtube
twitter
instagram
