Name *

First Name

Last Name

Phone *

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Are you looking for 1 on 1 Services for your child/teen? *

Not interested in 1:1 Services

1:1 Mental Health Services

1:1 Behavioural Services

Occupational Therapy Services

1:1 Educational Support

Are you looking for Group Services? *

Check any groups that may apply

Not interested in groups

Afterschool: Empowered Kids group

Afterschool: Mindful insights for kids 9-12

Afterschool: Mindful insights for Teens

Afterschool: Adaptive Minds for Kids

Afterschool: Adaptive Minds for Teens

Day Program: Balance Alternative Classroom

Saturdays: Sprouts social group - pre school

Saturdays: Sprouts social group - school age

Afterschool: Yoga For Kids / Teens

Summer - Mindful Connects 6-8/9-12

Summer - Balance Teens Group

Are you looking for Parent or Consultative Support services?

Not interested in parent/consultative support

Parent support services

BCBA / RBA clinical supervision

Professional consultative services

Are you interested in our in school supports?

Not interested in in-school supports

Looking for support for my child in school

Interested in our in-school groups for kids/teens

Interested in our in-school workshops for kids

Interested in our in-school training for teachers

Funding and Insurance *

I have insurance coverage for Psychotherapy / Social work

I have OAP funding

I have SSAH funding

I do not have funding or insurance

Other (please specify below)

How did you hear about us? *

Referral - word of mouth

Facebook group

Facebook Add

Instagram

Physical flyer

Other (please specify below)