Client, Teacher, and Physician Forms
Child and Adolescent Intake and Consent Forms
These forms are required to start the process for an assessment and to ensure we can offer you the service(s) you require.Direct To Therapy and Coaching Intake and Consent Forms
These forms are required to start the process for coaching, psychotherapy, and/or academic services and to ensure we can offer you the service(s) you require.
Requested Documents
Please send Report Cards, IEPs, and other relevant documents such as previous psychological reports. Files must be in pdf format.
Follow-up Forms (Ages 1-17)
This form should be filled out if requested by your practitioner. You must be a registered patient with the clinic and have an upcoming appointment scheduled.
Adult Intake and Consent Forms
These forms are required to start the process for an assessment and to ensure we can offer you the service(s) you require.Direct To Therapy and Coaching Intake and Consent Forms
These forms are required to start the process for coaching, psychotherapy, and/or academic services and to ensure we can offer you the service(s) you require.
Requested Documents
Please send Report Cards, IEPs, and other relevant documents such as previous psychological reports. Files must be in pdf format.
Follow-up Forms (Ages 18+)
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Physician Referral Form
DURING COVID-19, ALL OUR SERVICES CONTINUE TO OPERATE USING TELEMEDICINE ACROSS ONTARIO.
Parent Consent Form
Telemedicine (Video) Consent Form
Assessment and/or Treatment Consent Form
Medication Adjustment Agreement
Consent to Share Information Form
Payment Policy and Guidelines
Disability Tax Credit Certificate (DTCC) Agreement and Understanding
COVID-19 Liability Waiver
COVID-19 Patient Screening Checklist
Are you a Teacher? (Age 5 – 17 Student)
If a student has requested you provide feedback, kindly fill out our online form.
Are you a Teacher? (Age 1 – 4 Student)
If a student has requested you provide feedback, kindly fill out our online form.
Physician Referral Form
OUR SERVICES ARE PROVIDED BOTH IN-PERSON AND THROUGH TELEMEDICINE THROUGHOUT ONTARIO
Please note that we cannot accept referrals for court or medico-legal purposes, and/or cases with unresolved custody/access issues.
Get in touch with us
Visit our Shop!
Selected and curated by experts at our clinic
Learn, engage, and explore wondrous possibilities—for you and your family—in our new Possibilities Shop. Our store has expertly curated products recommended by our clinicians, and we’re excited to share them with you! Browse books we love for kid-friendly reading or deep insights, explore therapy tools, challenge your mind with some Brain Fun, or check out our Lifestyle section to enhance your life at work or home. We’re speaking with creatives, inventors, and visionaries about brand new products, too. So stay tuned—we’re just getting started!
Visit our Shop!
Selected and curated by experts at our clinic
Learn, engage, and explore wondrous possibilities—for you and your family—in our new Possibilities Shop. Our store has expertly curated products recommended by our clinicians, and we’re excited to share them with you! Browse books we love for kid-friendly reading or deep insights, explore therapy tools, challenge your mind with some Brain Fun, or check out our Lifestyle section to enhance your life at work or home. We’re speaking with creatives, inventors, and visionaries about brand new products, too. So stay tuned—we’re just getting started!
