Contact Form | Voice Legacy Solutions

Name *

Email address *

City & State *

I need help with *

Voice Banking
Message Banking
Legacy Products
AAC Implementation
Secure Storage of voice files
Something else

Primary language spoken at home *

English
Spanish
Italian
Other

Medical Diagnosis

ALS
Parkinson's
MS
Stroke/Aphasia
Huntington's
Prefer not to say

Approximate date of diagnosis *

Current stage of speech *

speech is still clear and strong
some changes beginning
noticeably affected
significantly affected

Are you currently working with a Speech Therapist? *

Yes
No

Name of therapist and Organization *

Preferred session format *

in-home visit
clinic or facility
remote/guided video session

If you prefer we contact a family member: name, relationship, and best contact method *

Do you currently have an AAC device? *

Yes
No
In process

Manufacturer of Device *

Tobii Dynavox
Smart Box
PRC
Other
I don't know

Additional Information we should know