Appointment Request

To ensure we provide the best care for your child, appointments are scheduled directly with our team. Please provide the information below and a member of our team will reach out to you within two business days.

Appointment Request

Date(Required)

Parent / Guardian's Email Address(Required)

Contact Phone Number(Required)

Parent / Guardian's Name(Required)

Patient / Child's Name(Required)

Patient / Child's Date of Birth(Required)

Reason for Appointment(Required)

Articulation

Infant Feeding / Swallowing Disorders

Pediatric Feeding / Swallowing Disorders

Language

Motor Speech Disorders

Oral Motor Function Skills (Birth - age 4)

OroMyofunctional Therapy (over age 4)

Tethered Oral Tissues (Tongue Ties)

Other

Notes and Details

CAPTCHA

Contact Us

10639 Meeting Street, Unit 101
Prospect, Kentucky 40059

Phone: 502-842-2428 (CHAT)
Fax: 502-842-2429
lori@chitchatchewky.com

Appointment Request

Contact Us

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