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ApraxiaResearch is providing the opportunity for a select group of families to receive an omega-3/vitamin E speech supplement complimentary for a 2 month study period. In return, those participating will be asked to submit detailed information about their child's experience and provide permission to share this information with other parents.

To see if your child will be selected, please fill out the form below and click on submit.
The review process takes approximately one week, after which you will be notified if your child has been selected. We will then send you complimentary product and a study kit.

Parent Information

Your Name*

Your Email*

Your Phone Number*

Address 1*

Address 2

City*

State*

Zip*

Child Information

Name*

Age*

Sex* Male Female

How would you rate your child's
speaking capabilities:*Verbal 5 4 3 2 1 Nonverbal

Why do you feel your child would benefit from the Omega-3/Vitamin E speech formulation?*