MJ Integrative Group Services
Our Integrative Group Services will focus on functional observation reported by parents and/or guardians as well as observation by the therapist during group sessions. Speech pathologists facilitating these group sessions will provide your children guidance in a structured setting. Children attending these groups will learn specified techniques to be able to practice, initiating with peers, keeping the conversation going, joining in a social scenario, staying on topic, perspective taking (Theory of Mind), emotional regulation and practice social problem-solving skills. This social learning theory provided by our speech pathologists will allow learning to occur in a structured setting, through observation and interaction with other peers. This will promote a neurodiverse environment for each and every child. Children will be paired based on age and skill-set.
Child's Name
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First Name
Last Name
Child's Birthday
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Month
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Day
Year
Date
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
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Please enter a valid phone number.
Can we send text messages to the phone number listed above?
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Yes
No
Email
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example@example.com
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How does your child currently communicate?
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Full sentences
2-3 word phrases
One word verbalizations
Speech generating device (e.g. TouchChat, LAMP, Proloquo)
Sign Language
PECS
Other
What areas would your child benefit from in a social skills curriculum?
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Turn taking
Sharing
Flexibility
Conversation Skills
Problem Solving Skills
Emotion Recognition
Friendship
Perspective taking
Other
Does your child receive private speech and language services?
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Yes
No
Name of facility where speech and language services are provided
Does your child receive ABA services?
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Yes
No
Name of facility where ABA services provided
Please check off any behaviors that your child demonstrates that should be taken into consideration when grouping your child with others:
Aggressive behavior (e.g. hitting, biting)
Self injurious behavior
Screaming/Yelling
Frequent tanrums
Eloping
Avoidance behaviors
Other
Does your child have any medical diagnoses?
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Yes
No
If so, what are the medical diagnoses?
Does your child have any food allergies or sensitivities?
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Yes
No
If so, please be specific in regard to allergies and/or sensitivities.
Is there any additional information that would be beneficial for us to know?
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Payment for Services
A 30-minute group session will be $50. A 45-minute group session will be $65. A 60-minute group session will be $80. By participating in our MJ KIDZ Totz and/or MJ KIDZ Friendz, I cannot and will not be submitting claims to my insurance company directly.
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Clear
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Please select the preferred group for your child:
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MJ Totz (Ages 2.5-4)
MJ Friendz (Ages 4+)
Please identify AT LEAST 5 times that work for your child for group services. The more time slots that you identify, the easier it will be to coordinate group services for your child.
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Morning (9:00-12:00)
Afternoon (1:00-3:30)
Early Evening (3:30-5:00)
Late Evening (5:00-7:00)
Monday
Tuesday
Wednesday
Thursday
Friday
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