Sliding Scale Financial Need Form

Purpose of this form: Wicked Clear Speech Therapy offers limited sliding-scale rates to make care more accessible. This form helps determine eligibility in a fair and consistent way. The information you share will remain confidential and will not affect the quality of your care.

Note: After submitting, you’ll be directed to the Let’s Get Started form, where you can share more about the type of therapy you’re interested in. Filling out both forms helps me understand your goals and your financial needs, so I can recommend the best plan for you.