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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. Participants will be asked to submit detailed information about their child’s experience and anonymously share this information with other parents. You may also be asked, but not required, to offer a testimonial after the study is completed.

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 study kit (we do ask you pay shipping).

Note that you must complete all required fields in order to submit your application.

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?*