Inquiry Type *

Services For Kids (Pediatrics)
ICBC Inquiry/Referral
Services For Adults/Seniors
Home Modification Assessment / BC Rebate for Accessible Home Adaptations
Ergonomic Assessment
Functional Capacity Evaluations
General Inquiry/Referral

Services Required *

Pediatric Services Required *

Occupational Therapy
Speech Therapy
Other

Occupational Therapy Goals (Kids) *

Speech Therapy Goals (Kids) *

Speech Therapy Goals (Adults) *

Diagnosis (if any)

Primary concerns

What is your child having difficulty with?

Additional Information

If you have any additional comments you would like to add, or additional contact numbers or emails you wish to provide please add that here.

ICBC Claim Number

Optional

Name *

First

Last

Child's Name

First

Last

Your Name (Parent/Guardian) *

First

Last

Email *

Phone

Child's Age *

Date Of Birth

Funding Source

Other funding source

You selected “Other” for a funding source, please list one or more sources.

Alert!

Occupational Therapy:
At this time we are not accepting children under the age of 6 with Autism (Using Autism Funding)* if the child does not have an ASD diagnosis and is under age 6, we can accept.

Speech Therapy:
Clients under the age of six we can accept.

Warning Alert *

I understand

City *

What city are you located in?

How may we be of service? (Questions/Comments/Main Concerns)

Questions, comments, etc.

Children are only seen at our Surrey Clinic (10090 152 St Surrey) *

I understand

Current Availability:

Please select all the dates you are available to attend from the options below. While this does not guarantee a booking, we will contact you to confirm availability.

SLP – Schedule

In Clinic – Mondays 10AM to 5PM
In Clinic – Saturdays 9AM to 12PM
Burnaby/Metrotown Area – Fridays 3PM to 5PM

We this does guarantee a booking. Please select all times that you can attend.

OT – Schedule

In Clinic – Mondays 2PM to 6PM
In Clinic – Tuesdays 12PM to 6PM
In Clinic – Thursday 2PM to 6PM
In Clinic – Fridays 3PM to 6PM
In Clinic – Saturdays 9AM to 5PM

Clinic @ 10090 152 St Surrey. We this does guarantee a booking. Please select all times that you can attend.

Acknowledge *

I acknowledge that completing this form does not secure a booking. Its sole purpose is to facilitate contact requests.

Occupational Therapy Pediatric Clinic Rates

Initial assessment $240 (90 minutes)

Treatment session $160/hour

Screening report $160

Report is not included for initial assessment.

Speech Therapy Pediatric Clinic Rates

Assessments/Reports
$160/hour

Treatment Plans

1. Speech Therapist 1on1 weekly @160/session

2. Speech Therapist 1on1 once per month ($160/session) and 1on1 with Therapy Assistant remaining weeks ($60/session)

SLP Pediatric rates Community (Burnaby Only)

The initial assessment is $180/hour plus the travel rate is $2.5/km

Screening report $160

Home visits/Treatment sessions are $180/hour plus a $2.5/km

Occupational Therapy for Seniors (Aging in place)

Assessment

Recommendations

Contact Us

Alert!

Current Availability:

Occupational Therapy Pediatric Clinic Rates

Speech Therapy Pediatric Clinic Rates