Child Learning Disability Questionnaire

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Should my child be assessed?

Learning Disability & ADD/ADHD Questionnaire

Unsure if your child has a learning disability?
Are they just lazy?
Are their problems due to online learning?
Is it simply a lack of motivation?

Complete the following free questionnaire to help determine if your child should be assessed.

We will send you a personalized email based on an analysis of your responses.

Please note:
--With all assessments, individuals must be fluent in English to provide accurate results.
-- In situations where a custody arrangement is in place with clients under the age of majority, both parents must provide written consent to the assessment process prior to testing commencement.

Does the individual display any of the following?

Check all that apply *

Very poor spelling Horrible hand writing Did not learn to read by age 6 Not working up to their potential Horrible in math/science Overwhelmed by workload School states "they need to put in more effort" Hates school Family is caught in homework "cesspool" Bores very easily Highly distractible Very poor "stick-to-it-iveness" Highly disorganized Will attend College or University soon

* Indicates required field

What is the individuals age? *

4-6 7-9 10-12 12-16 17-19 20-29 30-39 40+

An individuals age is required to determine the likelihood of any potential learning disabilities. All information is kept strictly confidential.

First Name of Individual Described Above *

We would prefer to know who we are communicating about so that we can personalize our contact with you. Thank you!

Gender *

Female Male Other

What service are you interested in? *

Which location is closest to you? *

Burlington Windsor

Name *

First

Last

We would prefer to personalize our email response to you. Please provide your name. Thank you!

Email *

Please enter your email address and Artemis A Team will contact you. We keep all personal information strictly confidential. Your email address will NOT be added to any lists without your approval. Your contact information will be removed immediately upon request.

Phone Number *

We will only call if you book an assessment, coaching, or therapy with our facility. Your contact information will be strictly confidential.

FAMILY STATUS *

Birth Parents Are Together Joint/Shared Custody Sole Custody Over 18/Does Not Apply

I agree to receiving marketing and promotional materials

Submit

go.oncehub.com/30MinCallWindsor go.oncehub.com/30MinCallWindsorPlease fill out the above form and Artemis will contact you directly.
All personal information is kept strictly confidential.

Alternatively, book your Free Intake Session.

or call us:

Windsor - 519-551-5414

CONTACT US TOLL FREE: 1-888-239-1483

Empower Your Child

"If a child can't learn the way we teach, then we should teach the way they learn." ~ Ignacio Estrada
Psychoeducational and Attentional Assessments level the playing field for your child enabling teachers to teach in the way your child learns.

Empower Yourself

Talking about our challenges can feel awkward and scary.
Our compassionate team of coaches, counsellors and therapists will help you find your strengths and resources to help you live your best life.