WebbSprout Intake Assessment Booking

Welcome!

Please share as much information as you’re comfortable with to help Ms. Webb prepare for your intake assessment.


Session options

  • Meet & Greet (comfort check and tour)
    30 minutes. This session is designed to confirm your child’s comfort and safety in the space before joining a group.
  • Full Intake Assessment
    60–90 minutes of structured time, including time with the whole family and individual time with the student. A written summary and recommendations for a personalized learning plan are included.

Fees

Intake sessions are billed in 30-minute increments at $60 per 30 minutes.


Scheduling

Intake sessions are often best scheduled during school hours, when students tend to have more energy, though after-school and evening options are available. At the end of this form, you can indicate times that work for your family.


Discovery Call

If you’d like a free discovery phone call before booking an intake, you can indicate that option at the end of this form.


After the assessment

We’ll review your goals, schedule, and budget. Ms. Webb will then prepare a tailored program proposal, which may include a combination of individual coaching, small-group sessions, and family support.


Privacy

Your information is confidential. Please only include details you feel comfortable sharing at this stage.


Email *
Student's full name *
Preferred name or nickname (what should we call them?) *
Pronouns *
Date of birth *
MM
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DD
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YYYY
Parent/Guardian name *
Please provide the name of the person you wish to be the primary contact for Ms. Webb at WebbSprout
Current home address *
Phone number(s) *
School name *
What grade are they in? *
Does your child maintain full time attendance at school?  Please explain. 
Please describe the issues your child is having. *
Please provide as much information as you feel comfortable sharing. 
What help are you seeking help from WebbSprout? *
Does your child have any relevant diagnosis?
Both medical and psychological diagnosis may be relevant. For example, ADHD, autism, learning disabilities, genetic conditions, psychological disorders, physical limitations, etc. 
Are there any situations at home or in their life that could be causing an issue such as a change in family structure, a significant loss, moving, or other issue that you feel might be relevant?
Please only share what you feel is necessary in this situation. A more detailed explanation can be provided further in the intake process. 
Does your child currently attend or receive any behavior or learning interventions either within school or through another extra curricular program?
Is your child enrolled in any recreational programs in the arts, sports, social clubs, or other activities in which they regularly engage?
What are your child's greatest strengths, talents, and abilities? What things do they most enjoy doing?
Is there anything else you wish to share?
What types of support are you interested in? *

Check any that feel relevant. This helps me understand where to start. You don’t need to be sure yet—there are no wrong answers.

Required
What days of the week is your child available for after-school or evening sessions?

If you are interested in sessions on the weekend, please add which times of the day you would be interested in attending. 

Also please indicate if you are able to attend during school hours or only after school. If your child is not attending school full time, there are more times available for support.
 *
Required
When are you available for an intake session? *
Please indicate what type of session you are interested in and what time works best for you. 

I allow for flexibility in booking sessions, trying to get as much productive time from the kids as possible to help establish a feeling of safety. 

It is a relaxed and low=pressure introduction to get a sense of what your child needs and to help them feel safe and comfortable in the space. Their consent is important and I want them to enjoy the experience and it starts with choosing a good time to meet. 

I will contact you to arrange a specific time to meet. 

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