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Speech-Language Pathologist Profile (OBT-SLP1)
First Name: Last Name:
Organization:
Organization Type: Inpatient Outpatient Private Practice
Role/Title:
Address:
Zip:
City: State:
Phone: Alternate Phone:
Work/Corporate Email:
Company Website:
How many Speech Language Pathologists (SLPs) are in your organization?
1-5 6-10 11-25 26-50 MoreThan 50
Are the clients you work with living with Aphasia? Yes No
Are your clients stroke survivors? Yes No
Are your clients living with Autism? Yes No
Are your survivor clients familiar with AAC/SGD technology? Yes No
Please rate your typical client's technical efficiency (ability to use a simple touch-screen device and recognize pictures, understand words and prases, and read text):
Low Functioning Medium Functioning High Functioning
I am seeking better technology to enhance communication between stroke survivors and their caregivers:
Next 30 Days Next 90 Days Next Six Months Next Twelve Months Not at this time
I recommend SGDs: Yes No
I recommend ___ SGDs per month: 1-3 4-6 7-10 10 Plus
I have the ability to purchase for my organization: Yes No
What SGDs have you recommended in the past? DynaVox Lingraphica Gus Communicator Tobii ATI Other
How did you learn about O'Brien Technologies and the Survivor Speech Companion System™?
Trade Show Print Advertisement Internet/Website Word of Mouth Other
Are you interested in learning more about the Key Center Program? Yes No
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