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 at CCCBSD will be in touch with you soon.

Clinic Form
Select the role that most closely describes your interest in seeking services from The Clinic at CCCBSD: *

Please provide the following information:

What services are you requesting from The Clinic at CCCBSD? (Check all that apply) *