Phone Consultation Form

In preparation for our potential time together, I’ve found that a phone consultation is key to getting my new families started off right. In this time together, I hope to find out what service will work best for you and your child and, in turn, how I can make the most of our time together.

Please complete the form below and I will be in touch with you via email to schedule a time for the phone consultation.

Your Name (Parent)

First Name

Last Name

Your Child's Name

First Name

Last Name

Your Child's age

Phone

(###)

###

####

Email Address

What is the best time of day for you for a brief (15-30 minute) phone consultation?

What is the biggest challenge your child is experiencing right now that has prompted you to reach out to InnerLinks Communication?

Would you be interested in working with a more holistic provider who treats more than just a diagnosis?

Yes

I'm not sure

On a scale of 1-10, how prepared are you to commit to therapy and home programs for your child to resolve this issue?

What other providers have you worked with to address your/your child's needs?

ILC is a family-centered practice. Are you open to participating in parent sessions if that is deemed the most appropriate course of action at this time?

What days/times are preferred for sessions?

What are some other questions that you'd like addressed during our consultation time?

How did you hear about Innerlinks Communication?

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All information transmitted through this site will be held in confidence. Email addresses will not be shared in any way.