Request for Appointment

Welcome to Northside Speech.

We would like to know a little about you. The purposes of this form are to:

  • give you some information about Northside Speech and how we work, to help you determine whether we are the right service for you and your family, and

  • collect the information required to determine whether we are able to provide you with the requested service, and

  • collect the information required to triage requests and allow us to manage the waitlist.

The information you provide is considered ‘health information’ under law. The information you provide is confidential and is stored securely, consistent with our Privacy Policy.

Our Privacy Policy and other terms and conditions are available at:

NOTE: If you are requesting appointments for multiple people (e.g. siblings), please complete a separate request for each person. While we try to offer appointments for siblings on the same day, it can confuse our computer system if you put multiple names on the same form.

Please note: you can save your progress and complete the form later, using the button at bottom of the page.


Before you refer, we would like to tell you a little about our service and values, to help you make sure Northside Speech is the right fit for you and your family.

Our approach to therapy is focused on providing targeted and meaningful support to address specific needs and goals. Our goal is to ensure that each appointment is purposeful and aligned with your objectives, so we may not offer therapy solely for the sake of it. Instead, we are committed to working collaboratively to achieve meaningful progress in areas that are important to you.





Please note that strict eligiblity criteria apply for the Clinics. See the linked pages for details. If we can see from your request and goals that your needs would be better met by a different Clinic, program, or Service, we will offer you an appointment in that program instead.


Thank you for your interest.

We will read and process the information you have provided.

We will use the information you have provided to:

  1. Determine whether we are likely to be able to provide the service you have requested. If we are not able to provide this service, we will suggest other provider(s) who may be able to assist you.

  2. Triage your request, and apply our current waitlist and/or booking procedures.

If we need more information, we will contact you using the details you have provided.

We will inform you whether a waitlist currently applies, and if so we will provide an estimate of how long the wait is likely to be.

If we currently have any appointments available to meet your needs, we will contact you to book an initial appointment. We will provide you will more information about what this will involve, and we may request more information from you.