Booking a Zero2Six Consultation Appointment-2024

Booking a Zero2Six Consultation Appointment

(Thank you for your interest in booking a consultation with a professional from Camino Wellbeing and Mental Health. The information that you share below will be shared with the professional from Camino Wellbeing and Mental Health you will be meeting with and will also be visible to the EarlyON professionals supporting our booking process. We treat all confidential information with the utmost respect and your information will not be shared beyond with those professionals who require it to support your family and your Zero2Six appointment.)
This consultation appointment must be made and attended by the child’s parent or legal guardian. Please complete the form below and a team member will connect with you.
Parent/Legal Guardian Name*

First NameLast Name
Child Name*

First NameLast Name
Child Birthdate*

MonthDayYear
Date
1. What is your KEyON QR code number? (number on the back of your KEyON tag). If you do not have a KEyON tag, email us at earlyyearsinfo@ytr.ymca.ca to start the process. A KEyON tag is not required to book this consultation.
2. How old is your child? (This appointment is for parents/legal guardians of children from birth to six-year old) ?*

0-6 months7-12 months13-18 months19-24 months2 years3 years4 years5 years6 years
3. I am the parent or legal guardian of the child and will attend the appointment.*

YesNo
If you answered "no" to the above question, you cannot book this consultation appointment. You must be a parent or legal guardian of the child listed in question 2 above.
4. Which EarlyON location you would like to book to attend?*
5. Which date you would like to book? (Please choose one only)*
5. Which date you would like to book? (Please choose one only)*
5. Which date you would like to book? (Please choose one only)*
6. What concerns do you have that you are hoping to talk with Zero2Six about?*
7. Is there anything else that you would like the professional meeting with you to know about? (I.e custody issues, involvement with other community professionals, medical diagnosis)?
8. Do you need an interpreter for your Zero2Six Consultation? If yes, what language interpreter do you need?*
9. Caregivers are strongly encouraged to avoid having their children present during their conversation with the Zero2Six staff member. EarlyON professionals are able to provide childminding for up to two children ages 18 months and up during your appointment if needed. Do you need childminding during your appointment?*

Yes, I require childminding during my appointment.No, I will not be bringing my child(ren).
If yes, please indicate the names and age(s) of the child(ren) requiring supervision.
10. Our team will connect with you via email or phone. Please enter your contact information below (email or phone number).*
Should be Empty: