New Clients Inquiries

Please complete the form below and we will reach out to you within 24-48 hours

Call or text us (587)-741-2620 for quick inquiries

Admin Hours: Monday - Thursday 10 am - 8:30 pm

Fridays 10 am-1 pm Saturdays 9 am-3 pm

Parent/Guardian Name

First Name

Last Name

Phone

(###)

###

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Preferred Location

First Name/Age of Child

Type of Support Service

Name of Insurance Company

How did you hear about us?

Area of concern(s) for your teen - in a few words

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