Intensive Program Registration Form

Registering for the Intensive Program Starts Here

There are two ways to register for intensive therapy. Either use our online form below or use the button below to download the form and return it to Smile Therapy for Kids by email. Email to i ntensives@smiletherapyforkids.com

A deposit of half the total cost may be required two weeks prior to the start of the intensive sessions.

Download the Printable Intensive Program Registration Form

or

Submit Online - Intensive Program Registration Form

Parent's Name:

Child's Name:

Child's Age:

Child's Date of Birth:

Phone Number:

Email Address:

Diagnosis:

Home/Mailing Address:

How many hours do you want per day?

Times Preferred:

Type of Services: Type of Services: Physiotherapy/Physical Therapy (PT) - CAN $130/hour * Intensive Strength Training (IST) -CAD $130/hour ** Suit Therapy (ST) - CAD $130/hour Occupational Therapy (OT) - CAD $130/hour Speech and Language Therapy (SLP) - CAN $ 155/hour TrexoRobotics - CAD $65/half hour Chiropractic - CAD $75/30 minutes Cortical Vision Assessment - CAD $200/hour

How many weeks will you attend?

Dates Preferred:

Other Relevant Information:

4 + 4 =

A deposit of half the total cost may be required two weeks prior to the start of the intensive.

* Physiotherapy/Physical Therapy (PT) = DMI Therapy, CME

** Intensive Strength Training (IST) = Most Suitable for children post-SDR surgery.

PT can also include Whole Body Vibration, NMES, Theratogs etc.