Let's Learn More About Your Child
This form helps our team learn more about your child and guide you toward the most suitable assessment options. Our Client Connection Team will review your responses and contact you to discuss next steps. This form usually takes 2–3 minutes to complete.
Parent/Guardian's Name
*
First Name
Last Name
Best Contact Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Preferred Contact Method
*
Phone
Email
Text
Best Time To Contact You
Morning
Afternoon
Evening
Child's Name
*
First Name
Last Name
Is your child currently seeing a therapist at STA?
*
Yes
No
What Has Led You to Seek Support?
What concerns or goals would you like support with?
Communication or speech
Social skills or friendships
Emotional regulation
Behavioural challenges
Attention or learning
Daily living or independence skills
Sensory differences
School or classroom challenges
Possible Autism assessment
Possible ADHD assessment
Recommendation from school / GP / therapist
General developmental concerns
Other
Can you tell us a little more about your child and what you’re hoping support will help with?
How soon are you hoping to access an assessment?
As soon as possible
Within 3 months
Just exploring options
Unsure
Thank you for sharing this information. Our Client Connection Team will review your responses and contact you within 24 hours.We look forward to supporting your child and family.
Submit
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