Dyslexia Phone Consultation Request
Start of your journey, The Dyslexic Way
Parent Full Name
*
First Name
Last Name
Child's Name & D.O.B
*
First & Last Name
DATE OF BIRTH
Contact Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Which form of communication do you prefer?
*
Call
Text
Email
All Are OK
What are you most concerned about with your child's reading and writing development?
*
What does your child’s schooling look like?
*
Homeschool
Public School
Private School
Other
Does your child currently have an IEP or 504? Select all that may apply.
*
Yes
No
IEP
504
If yes, please upload most current IEP/504
Browse Files
Drag and drop files here
Choose a file
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What time works best for you to have a 30/45 minutes phone consultation?
*
Please Select
Mornings
Afternoons
Evenings
Submit
Please allow up to 48 hours for our team to review your request.
Thank you!
The Dyslexic Way
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