Get Started. All information are kept confidential. "*" indicates required fields Tick the following signs and symptomsAcademic Performance: Declining grades: Sudden drop in grades, difficulty maintaining good academic standing. Loss of motivation: Lack of interest in schoolwork, decreased effort and engagement in studies. Attendance issues: Frequent absences, skipping classes, arriving late or leaving early. Attendance issues: Frequent absences, skipping classes, arriving late or leaving early. Difficulty with specific subjects: Struggles in certain subjects despite effort, needing extra help. Changes in study habits: Poor organization, procrastination, difficulty managing time effectively. Behavioural & Physical changes: Changes in behavior: Increased secrecy, withdrawal from family and friends, mood swings. Changes in financial habits: Asking for money frequently, borrowing or stealing money. Neglecting responsibilities: Skipping school, neglecting chores or hobbies due to substance use. Excessive internet or gaming: Leading to poor performance in school, withdrawal from family and friends. Use of substance: Use of drugs as a result from peer pressure, to feel good, ease their pain. Underage smoking: Smoking as a result from peer pressure, to satisfy curiosity, to show their independence. Significant changes in mood, appetite, or sleep patterns, often linked to relationship conflicts or insecurities. Withdrawal from social activities and hobbies they previously enjoyed, focusing solely on the relationship. Persistent sadness or hopelessness: Feeling depressed, withdrawn, and lacking motivation for activities. Excessive anxiety or fear: Constant worry, panic attacks, difficulty coping with stress. Eating disorders: Changes in eating habits, obsessive focus on weight and body image, unhealthy purging behaviors. Changes in sleep patterns: Difficulty falling asleep, staying awake at night, excessive sleeping. Social isolation or withdrawal: Avoiding social interaction, losing interest in friends and activities. Self-harm or suicidal thoughts: Cutting, burning, or other self-harming behaviors, talking about suicide or death. Association with risky peers: Friends known for substance use, criminal activity, or dangerous behavior. Lying or deception: Frequent lying about activities, whereabouts, or substance use. Additional Concerns: Sensory issues: Difficulty processing sights, sounds, smells, tastes, or textures, impacting daily life. Chronic health conditions: Medical conditions requiring ongoing management or impacting daily activities. Genetic disorders: Conditions affecting development, learning, or physical abilities. Sudden changes in personality or behavior: Dramatic shifts in mood, interests, or behavior without apparent explanation. Difficulties with self-care or hygiene: Neglecting personal hygiene, neglecting basic needs like eating or sleeping. Please provide more information or express any specific concerns you may have so that we can offer better assistance for your child. (Optional)Child's HistoryBirth History*- premature birth, low birth weight, c-section, assisted delivery, neonatal complications, genetic conditionsNoYesDetails of Birth History*-list the birth history Medical History*- previous illnesses and surgeries, allergies and chronic health conditions, medications currently taken, hospitalizations and any related diagnosesNoYesDetails of Medical History*-list the medical history Developmental Conditions*Has your child been diagnosed with any developmental conditions?NoYesDetails of Developmental Conditions*-provide details of developmental conditions Mental Health Conditions*Has your child been diagnosed with any mental health conditions?NoYesDetails of Mental Health Conditions*-provide details of mental health conditions History of Head Injury*Has your child had a head injury before? Concussions, car accidents, falls at home, bumps on the head that did not warrant medical attention, sports injuries, incidents that involved head traumaNoYesDetails of Head Injury*-provide details of head injury ProfileParent's Name* Contact Number*Child's Name* Age*Supplementary Information (Optional)Max. file size: 256 MB.Please upload reports (e.g. psychological report, medical report) here if you wish to supplement the application with with observations/reports done by other professionals.AvailabilityPreferred Appointment Day(s) I prefer a call first Mon Tue Wed Thu Fri Sat Sun Multiple choices allowedPreferred Appointment Timings Please key in your available timings for the preferred day.Information Use and Consent* By submitting this form, I have read and understood the statements below. I also consent to the collection and use of the submitted information. NeuroTree will collect information provided in this form to contact you, to understand your child’s needs and to provide support (if applicable) to your child. You have the right to request deletion of my/my child's/my ward's information at any time by writing in to NeuroTree. NeuroTree will not share your child's personal information with any third parties without my consent, except as required by law. I confirm all information is truthful. NeuroTree is not responsible for undeclared conditions. PhoneThis field is for validation purposes and should be left unchanged.