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Therapeutic Group Registration Form

Child In Mind offers in-person and virtual therapy groups for children, youth, and parents. Visit our Groups Page for full descriptions.

After submitting this form, we will contact you to schedule an orientation. Spots are limited and offered on a first-come, first-served basis. If a group is full, you will be placed on the waitlist for future groups.

Group Fees:

Fall/Winter: $100/hour. Commitment required for all sessions.


Most of our group services are covered under extended health benefits (psychological services) and treatment receipts are provided following each session. Please check with your insurance provider regarding your coverage. Payment is required after each session, including missed appointments.
Email *
Email  *
Parent 1 Name *
Parent 1 Phone Number  *
Parent 2 Name *
Email of Parent 2  *
Child Name *
Child's current age *
Child Date of Birth *
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Primary concerns *
Winter Group I am interested in
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Parent Groups
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Name of therapist (if your family is already seeking services at Child In Mind)
Are you a resident of Ontario?  If not, unfortunately we are unable to provide services to your family due to Provincial restrictions. *
Are there custody agreements relating to decision making authority? **We require consent from all guardians to provide psychological services to your child** In cases of sole decision making authority, please forward documentation to info@childinmind.com
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For families where shared consent is required, we require both parents consent and/or a copy of the court order indicating sole decision making authority. Child In Mind will not provide services to children until consent is received from all guardians. We will request a copy of the order when you have been assigned to a clinician.
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