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Have any Questions? +01 123 444 555

Registration adults

Registration for patients aged 18 and over

Registration is non-binding and takes place via this registration form. You will receive automatic feedback.

Diagnostic days take place at regular intervals (see Dates). The symptoms and the criteria are examined in detail in order to find out whether this therapy concept is suitable.
The right time for such an intensive therapy is also of great importance. If the criteria are met, we will discuss the therapy time with you. Please understand that you will have to expect a waiting period.
The groups must not be too large in order to be able to provide quality.

According to § 6 of the DSGVO we store your data for the processing of your order. Further information can be found in our privacy policy.

General data
Family doctor / ENT doctor
Allergies*
Do you suffer from depression?*
Do you have diabetes?*
Do you suffer from hearing or vision problems?*
Do you suffer from cardiovascular diseases?*
Do you suffer from respiratory diseases?*
Do you suffer from other chronic diseases?*
Are you taking any medication?*
Have you already been treated?*
Do you have a reading and writing disability or a learning disability?*
Do you have any other movements in your face or body?*
Do you avoid situations?*
Are you rearranging words or sentences?*
Are you limited in your everyday life?*
Does your stuttering affect your personal relationships?*
Are you reaching your career limits?*
Copyright 2019 D.E.L.P.H.I.N. Intensive stuttering therapy
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