West Coast Centre for Learning - Cogmed Working Memory Training Program (Child)

Cogmed Working Memory Training

An interactive, computer-based program designed to improve working memory and attention.

Cost: $ 1200

Date *

Participant

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Gender

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Parent/Gaurdian

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Relationship

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Other Parent/Guardian (if applicable)

Relationship

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What is your preferred method of communication? *

Text Phone Email Online Teams Meeting

Name of Learning Services Consultant (if known)

I understand that there is a time commitment and I will support my child to ensure that training is completed daily. *

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If available, I agree to release my child's assessment data to West Coast Centre for Learning. *

All information will be held in the strictest of confidence.

I agree I do not agree

Please upload assessment below.

How did you hear about us? *

Service provider (Pediatrician, General Practitioner, Psychologist, Counsellor) BC Psychological Association Internet Search Family / Friend Social Media Other

If by a family/friend or professional, please list their name below. If by other, please specify. If other, please specify.

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Will you be accessing funding to pay for the program? *

First Nations Health Authority Autism Funding Variety Funding Other (please specify) Bill me privately School Funding

Will you be utilizing extended health benefits? *

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Please feel free to add any additional comments or questions.

Electronic signature

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Thank-you for completing our Cogmed Registration Form!

Once you submit the form, you will receive a copy of your responses for your records. Shortly afterward, you will also receive an email with a link to schedule your consultation. This 30-minute meeting offers an opportunity to learn more about the program, clarify any details, and address any questions you may have.

Thank you for choosing West Coast Centre for Learning, we look forward to connecting with you. If you require immediate assistance, please feel free to contact us: info@wccl.ca or (778) 839-5515

By submitting this form, you consent to West Coast Centre for Learning collecting and using your information to respond to your inquiry. For details on how your data is stored and protected, please review our Privacy Policy.