Request Services

The Clinic provides services, consultation, and leadership to individuals – deaf and hearing – who have communication and developmental challenges, their families, and the professionals who engage with them.

If you are interested in seeking services, please fill out this form. Someone from The Clinic will be in touch with you soon.

Clinic Form

Please provide the following information:

Select the role that most closely describes you: *
What services are you requesting from The Clinic? (Check all that apply) *