About Us
Who Are We?
Our Therapists
What Is Occupational Therapy?
What to Expect?
Our Services
Children Services
Adult & Older Adult Services
Resources
10 Signs That Your Kiddo May Benefit From Feeding Therapy.
Contact
Service Inquiry Form
PHONE: 587-436-0881
Service Inquiry Form
Intake information
What type of therapy are you looking for?
Occupational Therapy
Physiotherapy
Psychology
Nutrition
Other
Have you received therapy before?
Yes and I have discharge reports
Yes
No
Do you have a diagnosis provided by a doctor?
If so, please provide your diagnosis(s) below:
Do you have concerns in any of the following areas?
Please check all that apply.
Activities of Daily Living (bathing, dressing, grooming, tolieting, etc.)
Instrumental ADLs (money management, transportation, meal preparation, medication management)
Home Safety/Accessibility
Falling
Cognition (memory, decision making, judgement, etc)
Play Skills
Socialization
Feeding
Fine Motor Skills (writing, scissor skills, picking up small items, etc.)
Gross Motor Skills/Mobility
Self Regulation (e.g.- too hyper, too calm, inability to focus, emotional highs and lows)
What are your main areas of concern?
Contact Information
Name:
City:
We provide services to Airdrie & Surrounding areas, travel fees may apply to some areas.
Phone
Email
How did you hear about us?
Website
Referrer's website (e.g.- ACOT, Children's Link, etc.)
Facebook
Other social media
Referred by friend or family
Other
Verification
Please enter any two digits
*
Example: 12
This box is for spam protection -
please leave it blank
:
Go Top