SPEAK OUT! Workbook & eLibrary Order Form If you need assistance, please email [email protected] or call Parkinson Voice Project’s Clinic at 469-375-6500 (Monday-Thursday 9 am-4 pm U.S. Central Time). Patient's First Name Patient's Last Name Patient's Phone Number Patient's Email (Order confirmation will be sent to this email address.) Patient wants a SPEAK OUT! Workbook ONLYPatient wants access to the SPEAK OUT! eLibrary ONLYPatient wants a SPEAK OUT! Workbook AND access to the SPEAK OUT! eLibrary NOTE: There is a 100 USD fee for shipping a workbook outside the U.S.Best shipping address: Type "N/A" if your patient ONLY requested access to the SPEAK OUT! eLibrary. Patient's Shipping Address Patient's Shipping City Patient's Shipping State/Province Patient's Shipping Zip/Postal Code Patient's Shipping Country SPEAK OUT! Provider's Information SPEAK OUT! Provider's Name SPEAK OUT! Provider's Email SPEAK OUT! Provider's Clinic Name I confirm this order is for a patient enrolled in the SPEAK OUT! Therapy Program. *Once you click submit, a message will appear at the bottom of the form in a green box. Parkinson Voice Project will never share or sell your information.