Name * First Name Last Name Email * Subject * What brings you to District Kids: Center for Minds and Hearts? * Interested in: Individual Therapy Social Skill building Parent Consultation Workshop Educational Assessment Summer Camp Options 2024 Structured Literacy Tutoring Age of perspective client (s) * By checking this box you indicate that you understand and agree to the following terms and conditions: The submission of this form indicates interest in connecting with a team member of District Kids: Center for Minds and Hearts. This initial consultation does not constitute the start of a professional relationship. This form is not appropriate for use in a crisis or emergency. Please call 911 or go to your nearest emergency room if you need immediate support. You are discouraged from sending detailed and sensitive personal health information using this form. We cannot guarantee your privacy and confidentiality using electronic communications. By submitting this form, you agree to accept the risks of transmitting your personal information via the internet and consent to being contacted via the methods you provide. Thank you for your inquiry!
