Inquire about Dyslexia Therapy | The Kid Connection

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Dyslexia Therapy

Thanks for reaching out! Fill out this form and we’ll get back to you shortly. In the meantime, feel free to jot down any questions or thoughts so we can hit the ground running when we connect.

Student First Name

Student Last Name

Student Birthday

Month

Day

Year

Current Grade Level

Student's School Currently Attending

Parent First name

Parent Last name

Parent Email

Parent Phone Number

Has your student been formally diagnosed with dyslexia?

Yes

If Yes, please upload documentation if available

If Yes, by whom?

Has your student previously received dyslexia therapy?

Yes

If Yes, please describe

Please share any specific concerns or goals you have for your student’s sessions:

I understand that therapy sessions are billed monthly.

I understand that consistent attendance is required for best progress.

I acknowledge that TKC requires a written notice to withdraw.

Parent/Guardian Signature

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Dyslexia Therapy Cost

$300

Dyslexia Therapy

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