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 the course duration includes 10 1-hour sessions, paid in advance. If I desire or need additional 1-hour sessions beyond the 10-session package, I'll be charged for the individual session and must pay in advance of the session.
I understand that there is a 72-hour cancellation policy for private sessions. I understand that if I cancel within the 72-hour window, I will need to purchase an additional session to make it up.
We respect your privacy and will never share your email address.