Request an Appointment

Request an Appointment
Phone: (517) 997-1790

Email: appointments@stoa-therapy.com

We're currently accepting patients and have same-week appointments available for eligible plans. Please complete this form so we can schedule your first appointment with us.
For myselfFor someone else
How old is the individual receiving services?*
ColoradoIllinoisLouisianaVirginia
About the individual receiving services

Please provide the following information for the individual receiving services. Ensure all details match exactly as they appear on the patient’s insurance card.
First Name*
Last Name*
Preferred Name (optional)*
Date of Birth*

MonthDayYear
Date
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Gender Identity*
FemaleMale
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What is the primary reason you're seeking speech therapy at this time*
YesNo
Session Preferences
YesNo

When are you available for an appointment?*

Insurance Information

Please provide the following information for the individual receiving services. Ensure all details match exactly as they appear on the patient’s insurance card.
Please upload a copy of the front and back of your insurance card*

Cancelof
YesNo
Consents

By submitting the form, you consent to Stoa using the times you provided to schedule your appointment with a therapist.
YesNo
How did you hear about Stoa?*
If you were referred to Stoa, please enter the name of the referring provider and their practice name*
Should be Empty:

About the individual receiving services