Your Name (required)

Your Email (required)

1. Your child’s gender and age?

2. Describe the problem.

3. How long has it been going on?

4. What have you done about it so far?

5. What symptoms/problems are showing? Academic, problems; social, sadness, anxiety, self-harm etc.

6. Describe what you want for your child?

7. When is the best time for you to talk?

8. What country/state and timezone are you in?

9. At what number or Skype name can we reach you?