Book a Consultation Your child’s Full Name * Date of Birth of your child * Gender Identity * Gender IdentityMaleFemale Name of the Parent * Primary Phone Number for contacting you * Email Address * Please select your preferred consultation mode * Select your preferred consultation modeClinic visitVirtual consultation Which of the following areas would you like to prioritize for support? (Select all that apply) Improving speech clarityMoving from single words to longer sentencesUsing more sophisticated communication skills ( from crying or pointing) for communicating needsBuilding confidence to try new food items and increase the number of safe food to her listMaking mealtime less stressful for the child and the familySupport with behaviours that feel hard to manage right now How did you hear about our clinic? How did you hear about us? *Referral from a Healthcare professionalFriend or Family MemberOnline Search/WebsiteSocial MediaWalk-by/Local AdvertisementOther When would be the most convenient date for you to have an appointment for evaluation? We will do our very best to find a slot that works for both of us * Best time to reach you *Morning (8 AM – 12 PM)Afternoon (12 PM – 4 PM)Evening (4 PM – 7 PM)AnytimeWeekends Only
