Group Speech Therapy (Stammering/Stuttering Management) Registration Form

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Note:

Membership fee for three month group therapy to pay at the start of the course is 14500PKR. Registration fee 500 PKR is inclusive. For international residents (outside Pakistan) course fee is 85 USD. Registration fee 5 USD is inclusive.

This membership fee offer is valid till further notice.

The duration of group therapy is 3 months. In this 6 sessions are with speech therapist, 3 sessions with Clinical Psychologist and 12 practice sessions.

Benefit of Membership: 10 to 20% discount on training and workshops offered from time to time.

Your name

Your age

Gender

PTCL Number / Cell Number

WhatsApp Number

Email ID

Emergency Contact Person Name

Relation with Emergency Contact Person

Emergency Contact Number

Country

State/City

Languages you Speak

Onset Age of Stuttering (Age when stuttering started)

History of Previous Treatment Related to Stuttering

If Yes, then specify the type of treatment

Have you ever experienced any kind of Group Therapy sessions for managing your stuttering?

Your Expectation regarding Group Therapy Sessions

From where you get information about SAY Global-Pakistan Stammering Foundation ?

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Transaction Date

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