Seeing My Time Group Course Intake Form

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  • Seeing My Time Group Course Intake Form

Please fill this out before the first class!

  • If the number of participants who would like to attend is different than the number you paid for in your registration, please email admin@efsuccess.info.
  • Please provide the full name of each participant, their preferred pronouns, and their relationship to the primary participant. Remember, if the primary client is a student, a least one parent or adult support figure MUST attend the sessions as well.
  • General Intake Information

  • ADD/ADHD, Dyslexia, Learning Differences, Gifted and Talented, Processing Disorders, Premature Birth, Adopted, Mental Health Diagnosis
  • Please let us know how you heard of us.
  • Additional Questions for Students and Families

    Please fill out this section if the primary participant is a student.
    I understand that a 100% refund is available up until two weeks before the first day of class. A 50% refund is available from two weeks prior to the first day of class through the second class. No refunds are available after the second week of class. I understand that if for any reason, the group environment isn’t suitable for myself or my student, I may apply the cost of the group course towards private sessions at a pro-rated amount.
    We respect your privacy and will never share your email address.
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