Selective mutism enquiry

In order to make the most out of our time, please fill out the questions below so that I can best serve you during our conversation. I will read your responses and prepare in advance for our time together.

I am looking forward to talking with you! When it is time for our call, it is YOUR responsibility to call me at the phone number that will be provided in your confirmation email after I receive this form.

If you need to reschedule, you may email me at least 48 hours in advance and we can reschedule.


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    As you have chosen the SM form, I assume that you are concerned about your child lack of communication outside your home, therefore is important to have an idea of what you are looking for and at what stage your child is at:



    Has your child been diagnosed with SM?


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