Booking – WonderMinds – Nurturing Young Minds

Child Information

Child's Full Name *

Age *

Gender *

Nationality *

Languages at Home *

Languages Child Knows *

Primary Concern (select one or more) *

Speech/Language Delay Behaviors / Meltdowns / Aggression Suspected Autism / Developmental Delay Learning / School Difficulties Attention / ADHD-like Concerns Social Interaction / Play Difficulties Sensory Issues (sound, touch, lights, etc.) Other

Parent / Guardian Details

Parent/Guardian Name *

Contact Number (WhatsApp preferred) *

Email *

Relation to Child

Appointment Preference

Preferred Mode *

In-Person (Center Visit) Online Tele-Consultation

Preferred Time Slot *

Morning Afternoon Evening

Medical History

Has the child been previously diagnosed or assessed? *

Is the child currently taking any therapy or medication? *

Note: This is a pre-booking request. Our team will review the form and contact you with the earliest available appointment slot along with required instructions.

Pre-Booking Appointment Form