Service Request

Required Field
Personal Info
Contact Info

This form is the first step, not a commitment on either side. It helps me understand what your family needs and whether I'm the right fit, or help you find who is, before we get into paperwork.

Other
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Where would you like to receive help?
Location of Service
Quick Fit Check

These help me make sure I'm set up to support your family well, or point you somewhere that is.

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(This doesn't rule you out, it helps me plan.)

Behaviour Companion is not a crisis or emergency service. If you or your child are in immediate danger, please call 911 or go to your nearest emergency department.

Other
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Scheduling & Location
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I cannot guarantee your preferred days/times, but I will do my best to accommodate. 

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What Happens Next

I'll review this within a few business days and follow up to talk through fit and next steps. If we're a good match, I'll send along your intake, consent, and confidentiality paperwork. If a different service or provider looks like a better fit for what your family needs right now, I'll tell you that honestly and help point you in the right direction.

Submitting this form doesn't commit you to services, and it doesn't guarantee a spot on my caseload.