Social Skills Group Interest Form

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Thank you for your interest! Please complete the questionnaire below and we will contact you to begin the enrollment process. Our groups will be age and ability matched in order to create the best environment to practice and refine their social skills.

Have more questions after filling out the form? Please feel free to call our office at 561-631-7723 or send us an email at info@projectspeechtherapy.com

Email *

Parent Name *

Phone Number *

Child's Name *

Child's Age *

Is your child currently a patient at Project Speech? *

Yes

Please describe how your child is struggling with social skills at this present time. *

Does your child struggle with friendships at school? *

Yes

Is your child able to/interested in participating with other children in group activities? *

Yes

Does your child share with others? *

Yes

Can your child follow simple directions? *

Yes

Can your child answer simple questions (verbally or using a device)? *

Yes

What are some of your child's preferred activities? *

How does your child transition away from preferred activities? *

What main area you would like to see improvement in during the program? *

Please list any food allergies or dietary restrictions. *

A copy of your responses will be emailed to the address you provided.

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