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Prospective Student
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Contact Us to Schedule a Visit
Parent/Guardian's Name
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Email
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Best Time to Call
AM (7 am - 11 am)
PM (12 pm - 3 pm)
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How did you hear about us?
Social Media
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Prospective Student
Current Age
Gender
Male
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Current Grade Level
Kindergarten - Second Grade
Third Grade - Fifth Grade
Sixth Grade - Eighth Grade
High School
What is your child's diagnosis, if any?
ADD/ADHD
Autism Spectrum Disorder
Learning Disorder (Dyslexia, Dysgraphia, or Dyscalculia)
Auditory Processing Disorder
Mood or Behavior Disorder
Speech/Articulation Disorder
Anxiety
Sensory Processing Disorder
No Diagnosis
Waiting on Evaluation
Is your child currently receiving any counseling or therapy services?
Speech Therapy
Occupational Therapy
Physical Therapy
ABA Therapy
Counseling (Family or Individual)
Issues your child is currently experiencing in school:
Making/Keeping Friends
Class Size Too Big
Anxiety
Poor Grades
Test Taking
Poor Social Skills
Completing Classwork/Homework
Aggressive/Destructive Behaviors
Suspension/Expulsion
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