PARENT INTAKE FORM

Please take the time to fill out our clinic intake form before your first appointment. 

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Has your child had direct contact with any social agency or mental health professional (psychologist, psychiatrist, social worker) in the past?
Is your child currently taking medication?
Has your child taken medication in the past?

989 Eglinton Avenue West. Suite #1

Toronto, ON M6C 2C6

The COPE Clinic

Child and Youth Psychology

© 2019