Hello! Thank you for reaching out to us! Completing this quick questionnaire will help us alert our amazing staff about your speech language, literacy, or tutoring needs.
Once this form is complete, someone from our office will reach out to you as soon as possible via email. 
Sign in to Google to save your progress. Learn more
Please note that Brooklyn Letters is the parent company of Manhattan Letters, Long Island Letters, Queens Letters, and Staten Island Letters.
What is your first and last name?
*
What is your email address?
*
What is your phone number? What are the best times to call or text you?
*
If you are a parent, what is your child’s first name, age, and grade? If you are an adult, please state so.
*
We are not brick and mortar, but travel throughout the NYC metro area. We will come to you! What is the zip code and cross streets of where you want services to take place? If you want remote services, please let us know that you prefer remote services. We also offer hybrid too! If you are unsure, we can talk about it. *
For speech language therapy services, what are your concerns about your/your child's speech? If you are not sure, just state it the best way you can and we will follow up with all the right questions. 
For literacy or writing support or other tutoring services, what are your concerns about your/your child's educational needs? Feel free to just put it in your own words. We will understand and ask more detailed questions.
For private SEIT services, what needs does your child have in the classroom (or at home), what is the location of the school or home (cross streets and zip), and what days of the week and times is a SEIT needed? Our SEITs are private pay and not employed by the DOE. Their rates will range in the $125-175+ per hour range, depending on location and needs of the student.
Have you/your child had any prior speech language evaluations, neuropsychological evaluations, or formal literacy/writing/math assessments, or is your child have an IEP? If yes, when was the most recent evaluation/assessment/IEP update? If an evaluation or assessment is needed, we can do that! *
What days of the week and times would you/your child be available for therapy or tutoring sessions and/or an evaluation (if needed) so that we can match your schedule with our therapists and tutors?
*
When would you like to start services?
*
We do not accept any third party payments, including insurance, Early Intervention, Board of Education (CPSE/CSE), Enhanced Rates, RSAs, Vouchers, Medicaid, Medicare, etc. Are you comfortable paying us out-of-pocket?
*
Our therapy and tutoring rates ranges are below. 
How did you hear about us? If you were referred, who can we thank?
*
Thank you, and we will be in touch soon!
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Brooklyn Letters. Report Abuse