Home
About
Services
Forms
FAQs
CONTACT
Registration Form
Please fill out the form below if you are interested in any of our services.
Please enable JavaScript in your browser to complete this form.
Please enable JavaScript in your browser to complete this form.
Parent's Name
*
Child's Name
Child's Date of Birth
Child's Age and Weight
*
Why do we ask? Safety. When it comes to therapy, it is most important that I keep your child and myself safe during all handling. Please be honest with me. If your child is over 40 lbs (18Kg)., then the activities that are completed during treatment may be limited.
Email
*
Phone Number
Type of Service
In-Home (Mobile) Physiotherapy & DMI
Gross Motor Therapy/ DMI Intensives
Telehealth Consultations
DMI Travel Intensives (Outside of Vancouver, Lower Mainland)
Birth of Concern
Diagnosis or Main Concern
Submit
