request appointment

Complete this form or call us to request an appointment at the Child Mind Institute. Our team will contact you to schedule your visit.

Locations

Vaughan
Markham
Toronto
Oakville

Working Hours

Mon - Sat: 09.00am - 07.00pm
Sunday: Holiday

Phone

202-555-0188

contact@example.com

I am

Please select one of the options below.

Requesting services for a child/dependent

Requesting services for self (must be 18 or older)

Referring a patient (as a provider)

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First Name

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Last Name

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Please enter a valid email address.

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Phone

Please enter your phone number with area code.

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Send me the latest evidence-based resources.

Consent to SMS

I agree to be contacted by SMS text message.

Secondary Contact First Name

Please enter the first name for a secondary contact.

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Secondary Contact Last Name

Please enter the last name for a secondary contact.

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Secondary Contact Email

Please enter a valid email address for secondary contact.

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Secondary Contact Phone

Please enter the phone number for secondary contact.

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Child First Name

Please enter your child's first name.

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Child Last Name

Please enter your child's last name.

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Reason for Seeking Treatment

Please describe why you are seeking treatment.

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Location

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Frequently Asked Questions

Answers to common queries about our services and how we can assist you.

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request-appointment

request appointment

Frequently Asked Questions

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