Intake Form - The Portia Learning Centre

Thank you for your interest in our services. Please complete this Client Registration Form to provide sufficient information to assess how we can be of service. Once completed, your child will be added to our waitlist for service intake, and we can begin to assess an appropriate path towards beginning treatment.

Registration Form

Thank you for your interest in our services.

Please complete this Client Registration Form to provide sufficient information to assess how we can be of service.

Once completed, your child will be added to our waitlist for service intake, and we can begin to assess an appropriate path towards beginning treatment.

We are available for phone consultation should you have any questions or general inquiries.

Please reach out to Pam at 613-355-3303 or info@portialearning.com.

Registration Form

Parent/Caregiver Information

Child Information

Child Profile