check

FREE Discovery Call Request

Welcome to the Evolve Movement online client intake form. Here’s what to expect:

  1. Submit the online form below (it takes 5 minutes to complete).
  2. You will receive an official welcome email along with a request for additional information about your neurodivergent child and family.
  3. Once we receive additional information from you, our team will reach out via email within two business days to schedule an initial 30-minute consultation via Zoom to discuss recommended next steps.

We look forward to creating a service plan to meet your family’s unique needs!

Fondly,

Christine and The Evolve Team

Click the button below to start.

Start

General Family Information

Please provide the following informations

Note that all the information provided in this form will be kept confidential.

Click "Next" to continue.

Question 2 of 15

Neurodivergent Child First Name 

Question 3 of 15

Neurodivergent Child Last Name

Question 4 of 15

Parent/Guardian First Name

Question 5 of 15

Parent/Guardian Last Name

Question 6 of 15

First/Last Name of Other Children (write "none" if not applicable)

Question 7 of 15

Email

Question 8 of 15

Phone

Question 9 of 15

Can we send you texte messages to that phone number?

(Select all that apply)
A

YES

B

NO

Why You’ve Come to Evolve

Please provide some background information

Click "Next" to continue.

Question 11 of 15

Medical diagnosis of your neurodivergent child

Question 12 of 15

Primary Reasons for Seeking Care with Evolve

Question 13 of 15

Family members in need of support (check all that apply):

(Select all that apply)
A

My special needs child

B

Sibling of my special needs child

C

Me

D

Me and my partner

E

Not sure

Evolve services are you interested in

Click "Next" to continue.

Question 15 of 15

Evolve services are you interested in: 

(Select all that apply)
A

Information about joining Evolving Together, a global membership community for parents & caregivers of differently-abled children

B

Emotional Health & Well-Being (ex: Conscious Parenting Coaching, Collaborative Problem Solving, Psycho Bio Acupressure, Counseling & Hypnotherapy, EFT, etc.)

C

Cognitive & Physical Development (Ex: Anat Baniel MethodⓇ NeuromovementⓇ Brain Integration Technique , Listening Training, etc.)

D

Mindfulness & Play (Ex: Heart Math, Yoga, Meditation and Breathwork, Sound Baths, etc.)

E

Nutrition & Supplementation (Ex: Nutritional Evaluation & Planning, Blenderized Diets, Detoxification for the Whole Family, etc.)

F

I'm not sure what my family needs

Confirm and Submit