Please use this form to request an evaluation by a speech-language pathologist. If the child does not have a Mass General Medical Record Number, call 1-866-211-6588 to register and obtain one. Please also have the child’s pediatrician send a signed doctor’s order to our department (fax: 617-724-0771). We cannot schedule an evaluation without the child’s MassGeneral Record Number and a signed doctor’s order. A staff member will be in touch shortly.

Requestor Information

If you are an international patient, please complete the International Patient Appointment Form.

Patient Information


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