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- Speech-language pathology (SLP)
- Occupational Therapy (OT)
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**Note: Only daytime hours available at this time (therapy during school hours). Please indicate if you would like to be waitlisted for after school hours, or begin daytime hours sooner.**

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Please complete the form below to be put on the waitlist for SLP or OT services.

**Note: Only daytime hours available at this time (therapy during school hours). Please indicate if you would like to be waitlisted for after school hours, or begin daytime hours sooner.**

Caregiver's name

Child's name

Phone number

Child's birthdate

For which therapy services are you contacting Confident Kids?

Speech-language pathology (SLP)

Occupational therapy (OT)

Has this child previously received SLP or OT support?

No previous therapy

SLP

FOR SLP INQUIRIES, please check the box(es) below for the general area(s) of communication that you are hoping to address in therapy.

SPEECH SOUNDS (the sounds we make)

EXPRESSIVE LANGUAGE (the words we say)

RECEPTIVE LANGUAGE (the words we understand)

SOCIAL/PRAGMATIC LANGUAGE (how we communicate)

FLUENCY/STUTTER (speech fluency)

AAC (alternative or augmentative communication)

OTHER (please discuss below in form)

Please write a brief inquiry message.

Sometimes replies from info@ConfidentKids.ca go to junk email folders. Please check within the next 5 business days for a response.

Thanks for submitting!

Your inquiry will be responded to within 5 business days.

Thank you for your patience!

info@ConfidentKids.ca

#200 - 5405 Ladner Trunk Rd.

Delta, BC, Canada

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