Tell us more about you and your child
The answers you provide to the following questions will help us have an understanding of yours and your child's needs so that we can match your child with the most suitable therapist for yours and your child's needs.
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WhatsApp phone number?
Parent Name and Surname
Where do you live?
About how much one-on-one time do you spend with your child each day?
Less than 1 hour
More than 1 hour
Do you have medical aid?
Does your medical aid cover therapy services?
I do not have medical aid
About your Child (Behaviour and Development)
Your Child's Name and Surname
Child's Date of Birth
School and Grade
What are your concerns for your child? Tick those that apply
Not reaching baby milestones like crawling
Struggling with reading and understanding stories
Struggling with writing, drawing and colouring
Struggles to concentrate or focus
Not able to remember words or instructions
Avoids touching things or loud sounds
Is going through an emotional time
Not speaking clearly
Does not like to socialise
Has your child received therapy before?
Health: Any illness, disability or diagnosis?
What does your child like to do? Tick all that apply
TV and playing indoors (puzzles)
Being social with friends
Drawing, painting and creating
Which of these would make your child excited? Tick all that apply
Your Home and Technology
Technology available at home?
Ipad / Tablet
Connectivity at home?
Toys available in your home? Tick all that apply
Paper and pencils
Where did you hear about us?
Facebook or Instagram
Family or Friends
When are you most available for the initial consultation?
Anytime / Flexible
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