Submit this form to pay for the Speech/Language Therapy Sessions Parent Name(Required) First Last Email(Required) Student Name(Required) First Last Date(s) of Session(Required) 15 Minute Therapy Session Quantity Price: $20.00 Quantity Custom Session Fee Quantity Price: $26.50 Quantity 30 Minute Therapy Session Quantity Price: $40.00 Quantity Total Credit CardCard Details Cardholder Name
