Reading Time: < 1 minute Your name Your age Gender SelectMaleFemaleOther PTCL Number / Cell Number WhatsApp Number Email address Emergency Contact Person Name Relation with Emergency Contact Person Emergency Contact Person Number Country State/City Languages you Speak Which alphabets/sound cannot be articulated (spoke) by you? History of Previous Treatment Related to ArticulationSelectYesNo If Yes, then specify the type of treatment SelectMedication (Allopathic)HomeopathicHerbalSpeech TherapyAny Other Mode of Taking Sessions From SAY Global - ITS(AM) SelectFace-Face (In-person) Session at ClinicOnline Session From where you get information about SAY Global - ITS(AM) SelectFacebookInstagramThrough a FriendSnapchatYoutubeLinkedInWhatsAppEmailWebsitePrinted MediaAwareness Tele CallOther This form was filled by SelectSelfMotherFatherOther Choose from these Speech therapist SelectMs. Hina (3000)Ms. Munaza (2000)Ms. Amber (2000) Select Payment Mode SelectJazz Cash (0321 47 11 407)Telenor EasyPaisa (0345 42 42 506)Meezan Bank Account (0231 - 0101717462)IBAN ACCOUNT NO: PK86MEZN0002310101717462 upload receipt Transaction ID Transaction Date We accept Terms and Conditions
