Facilitated Family Discussion.
Thank you for choosing to improve the digital health of your family. By developing a family culture in relation to device usage you are re-enforcing healthy values, relationships, setting boundaries, engaging self-control and improving mental and physical wellbeing over and above protecting your loved ones from the dangers of the internet. These discussions can be difficult and strain relationships which is why we offer a facilitated discussion option with a healthcare professional.

Please fill in the form below to book a facilitated discussion.
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Email *
Name *
Address
Phone number *
Promotion code
Due you require an in-person or virtual discussion? (In-person discussions are only available in the Cape Town area at this stage.) *
Required
Family members ages (This will help us prepare appropriate questions. *
Required
Devices used in the home. *
Required
Areas of concern regarding device usage
Specific requests
A copy of your responses will be emailed to the address you provided.
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