New Patient Info Sheet
NP VOICE CASE HISTORY
NEW PATIENT CHILD

 

 

Kate Samples Williams, M.S., CCC-SLP
John M. Samples, Ph.D., CCC-SLP
3859 Montgomery Drive Santa Rosa, CA 95405
Phone:  707-542-1010  Fax:  707-542-3232

 

 

Thank you for choosing us to help you with your speech therapy needs.

 We have enclosed our new patient questionnaire for you to complete prior to your appointment with us.  If you could fill this out to the best of your ability and bring it in with you on the day of your appointment we would greatly appreciate it.  Please bring any reports or documents that you think would be helpful to get to know you better.  We can make any additional copies here for your convenience.

Your trust in our knowledge and expertise is very important.  Our commitment is to provide you with an accurate evaluation along with recommendations for the best course of treatment in a caring and compassionate manner.

If you need to cancel or change your appointment please call 707-542-1010 during normal business hours or after hours at 707-799-4832.
You can email us directly at any time at santarosaspeechlanguage@gmail.com

We look forward to meeting you soon!

Sincerely,

Santa Rosa Speech & Language Services