Name
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First Name
Last Name
Phone
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(###)
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Email
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Age of Child and Diagnosis (if applicable)
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Select any of the following that may apply to your child/teen to help us better understand your families needs:
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What is the reason you are inquiring for services ?
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Are you inquiring about our Child Development Services?
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Individual services: Early intervention, autism services, ABA, OT, play therapy,
Groups: sprouts play based early intervention group, adaptive minds for kids, girl power, empowered kids
Are you inquiring about our Mental Health Services?
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Individual services: Social-emotional learning support, Counselling, psychotherapy, play therapy, walk N' talk.
Groups: Mindful insights, girl power, empowered kids
Are you inquiring about our Educational Services?
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Individual Services: Executive Functioning Coaching, in school support, Learning disability support, specialized tutoring.
Groups: Balance Alternative Classroom, Adaptive Minds for kids, Homework Club, Adaptive Minds for Teens.
Are you inquiring about Social Groups for Neurodivergent children/teens?
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Specialized groups for youth with Autism, ADHD or other exceptionalities
Are you inquiring about our Wellness Enrichment Social Groups?
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Special interest groups, Yoga and Mindfulness for kids and teens, Digital Art for kids and teens,
In-School Wellness enrichment workshops (Mental health, mindfulness, Yoga and more)
Funding, Insurance and Financial Aid
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How did you hear about us?
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Additional info and/or questions
Thank you for your submission!
A member of our team will reach out to your shortly
