Start your intake

Tell us about your child and family using the form below.

We’ll review it and get in touch to arrange a consultation.

Have a question first? Contact us

How our program works

Intake form

Uploading your FSCD contract is optional. If you attach one, it’s emailed to Supportive Steps with your form, and a copy is kept securely on our website.

Parents/Guardian Name

Child/Children Names

Child/Children D.O.B

Phone

Email Address

Address Line 1

Address Line 2

Home Address

City

Province

Postal Code

Has your child been diagnosed with any conditions? (e.g ADHD, ODD, Autism etc. ) If yes, please provide diagnosis date.

Are there any particular strategies or interventions that have been successful in the past?

List some of your child's strengths and hobbies.

What are your expectations or hopes from this program?

Are you a part of FSCD (Family Supports for Children with Disabilities) if yes, please upload a copy of your contract.

Which of the services would you require?

In-Home Respite Community Respite Program Personal Care Services Extraordinary Childcare Services (Before and After School Care) Overnight Respite Program Cleaning Services for Families

What days are you looking for service (Add days, mornings/afternoon/evening)

If there is anything else you would like us to know about your family. Please share here

How would you like your initial consultation?

Phone Call Video Call

Start your intake

Tell us about your child and family using the form below.

How our program works

Submit intake form

Consultation

Receive care

Intake form