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Request a Free Phone Consultation
Please complete this form to request a free 15-minute phone consultation with Julie at Many Gifts Speech & Language Therapy.
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Email
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Your email
Your name:
*
Your answer
Your phone number:
*
Your answer
Please tell us a little bit about the reason you are reaching out to us.
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Your answer
What primary insurance plan does the potential client have?
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Aetna
Blue Cross Blue Shield
Cigna
Harvard Pilgrim
Kaiser Permanente
MassHealth
MassHealth: Mass General Brigham ACO
MassHealth: Tufts Health Together
MassHealth: Wellsense
Tufts Health Direct
Tufts Health Commercial
TriCare/Humana
Tricare/Champus
United Healthcare
UniCare State Indemnity
Other:
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Does the potential client have secondary insurance? If yes, please check off "other" and enter the plan name.
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No secondary insurance
Other:
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Do you need a video call as an accommodation for the consult?
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Yes, I am Deaf/HOH.
Yes, I am an AAC user.
Yes, I need this accommodation for another reason.
No
Required
Would you kindly let us know how you found our practice?
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internet search --> website
referred by a doctor or other provider
referred by friend or family member
Apraxia Kids Directory
Meaningful Speech Directory
Facebook
Other:
Required
Please let us know some days/times that would be a good time for us to call you (e.g. day of the week + morning/ midday/ afternoon/ evening).
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Your answer
A copy of your responses will be emailed to the address you provided.
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