Brain Bloom Room | Wondering if our service is right for you or your family?

Wondering if our service is right for you or your family?

Please fill out the confidential form below and one of our Neuro Coaches will be in touch to discuss our programme with you.

Name

Where are you located?

Phone number

Email

Child's name (if enquiring about)

Child's age (if enquiring about)

Do they go to school or are they homeschooled?

School year

Do they have friends at school, play with other kids?

Formal diagnosis (if applicable)

Chief concerns

Pregnancy and delivery complications (if applicable)

Breastfeeding issues?

Any immune or autoimmune issues (e.g. eczema, allergies etc)

Developmental milestones (when did they sit, crawl, walk, talk)

Do they communicate verbally?

Can they read body language? (e.g. facial expressions)

Can they give eye contact?

Do they recognise themselves in a mirror?

Do they know their body parts?

Do they care about their appearance?

Reading

Writing

Maths

Any unusually strong skills (e.g excellent memory for details, locations, memorising songs, books etc.)

Emotional issues

Any sensory issues? (Hyper/hypo)

Do they feel pain?

Do they have a sense of smell or taste?

Picky eater?

Dietary issues

What activities do they do? (e.g. sport, dancing, martial arts, music)

Any balance issues?

Any stims, tics or OCD behaviour?

Any toileting issues?

How did you hear about us?

Address

Message Sent.

Brain Bloom Room

123 Grey Street

Hamilton East

Hamilton

New Zealand

admin@brainbloomroom.com

Phone: (+64) 027 3199886

Testimonial

“ Within the first month of working with you, our son started showing a willingness to do homework. His handwriting and swimming have improved and he can now listen to and focus of his instructions from his Coach. He can now ride a bike without training wheels and he is better at social skills, making friends and keeping them.”

Bianca

Whāngaia, ka tupu, ka puawai

That which is nurtured, blossom then grow

Wondering if our service is right for you or your family?

Testimonial

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