Appointment Request & Intake Forms

Appointment Request Intake Form

The information you provide will only be used for booking appointments. As with any communication over the internet, this form may be intercepted by a third party. Submission of this form indicates that you accept this risk.

Alternatively, you can leave us a voice mail at 647-236-4263. After we receive your request form or voicemail, one of our therapists will contact you within 3 business days.

Although we update our availability regularly, it is possible that an appointment time listed below may have already been booked based on the flow of inquiries.

Services By Location:

Clinic - in-person Speech Therapy (658 Danforth Avenue at Pape)

Clinic - in-person Occupational Therapy (658 Danforth Avenue at Pape)

Home Visits Etobicoke, New Toronto, & Toronto West

Home Visits North Toronto & Scarborough

Virtual Services

To add your child to the waitlist or facilitate booking please provide the following information:

Child's first and last name:

Parent/Guardian Name *

Email *

Best Phone Number:

Child's Date of Birth *

Grade *

Please provide any additional information that will help us understand your child's needs:

Address *

Address

Street Address

Apt, Suite, Bldg. (optional)

City

State/Province

Zip/Postal

Address