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CONTACT US:

757-422-6342

info@socialbutterfliesclub.com

ADULTing PROGRAM:

Social Learning

adultingprogram.com

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Ask us a Question or Request an Appointment

Complete one of the forms below and our office manager will get back to you as soon as possible. Feel free to call our main office at 757-422-6342 to chat.

ASK A QUESTION

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Name*
First Last
Email*
Phone
Comments*

REQUEST AN APPOINTMENT

Phone
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Schedule Information

Please select a day and time you prefer. Our office manager will contact you with an appointment day/time. Please note that we will offer first available appointments that may not coincide with your selection. However, we will do our best to accommodate each request!
The best day for me/my child is*
The best time is*
*Please note that we have groups during the 3:00-6:45 time frame each day. We will do our best to accommodate your time frame request!
Client Information- Pediatric ONLY (ages 2 1/2-17) *ADULT Clients, Please scroll to the form below for the Adult Intake Form
Child Information
My Child's Name*
First Last
My Child's Date of Birth*
MM slash DD slash YYYY
Child's current grade level*
Child's current school
My child's main communication method is*
- Verbal
- Sign Language
- Communication Device
- Picture Communication
- Non-Verbal
Does your child have difficulty asking and/or answering questions? (with peers or adults)*
- Yes
- No
Does your child have difficulty taking turns with others? (During an activity and/or verbally)*
- Yes
- No
Does your child have difficulty making friends because he/she prefers to play alone or does not like to share?*
- Yes
- No
Does your child walk around the perimeter of the playground or prefer to play in the sand box?*
- Yes
- No
Does your child “get stuck” on one topic or type of toy?*
- Yes
- No
Does your child have a speech-language delay or a fine/gross motor delay?*
- Yes
- No
Does your child have difficulty in the classroom setting and following the rules of the class? (Sitting for circle time or structured tasks,standing in line, following directions, etc.)*
- Yes
- No
Does your child CURRENTLY have behaviors that are NOT typical of peers that interfere with their daily activities (playing with peers, transitioning to tasks)? PLEASE NOTE that we are NOT able to accommodate the following behaviors if they are not being addressed by a behavioral professional: elopement, hitting, kicking, biting, spitting, destruction of property, or harmful behaviors to self or others.*
ALL INFORMATION WILL REMAIN CONFIDENTIAL AND IS FOR ASSESSMENT PURPOSES ONLY
- Yes
- No
Has your child received any intervention for these behaviors?*
ALL INFORMATION WILL REMAIN CONFIDENTIAL AND IS FOR ASSESSMENT PURPOSES ONLY
- Occupational Therapy- Self Regulation/Sensory Integration
- ABA (Applied Behavior Analysis)
- PCIT (Parent Child Interactive Therapy)
- Behavior Therapy/Play Therapy with Psychotherapist
- 1:1 Psychotherapy with therapist or counselor
- OTHER- Please explain in comments below
Please give us details on the types of behaviors your child exhibits. Please note any elopement, hitting, kicking, biting, non-compliance, etc. and the possible causes for these behaviors. PLEASE NOTE that we are NOT able to accommodate any of the above noted behaviors if they are not being addressed by a behavioral professional. We are happy to refer to a local behavioral specialist if the behaviors are not being currently addressed.*
ALL INFORMATION WILL REMAIN CONFIDENTIAL AND IS FOR ASSESSMENT PURPOSES ONLY
Tell us about your concerns (optional)
Parent Information
Parent Name*
First Last
Email Address*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone number*
Number where you can be reached to schedule an appointment
Referred by (please check one)*
- Doctor
- Family
- Friend
- Close to Home/Work
- Website
- School
- Other
If "Doctor", enter the doctor's name
If "Other", enter more information
I understand that there is an initial social communication assessment fee of $99.00 that is due PRIOR to the day of the service. To secure my appointment, there will be a non-refundable $25.00 deposit due now. The deposit is applied to the total assessment fee at the time of the assessment.*
* Enter your initials
I understand that my $25.00 deposit is due today and will be applied to the total assessment fee. I understand that if I do not keep my appointment or reschedule within 24 hours, the deposit is non-refundable.*
- Yes
- No
Deposit
Price:
Total
$0.00
Credit Card*
Card Details
Cardholder Name
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About Us

The Social Butterflies Club was founded in 2004 by Rhonda Osisek M.S., CCC-SLP. Rhonda created this program for a few of her clients that were having trouble interacting appropriately at school.

Social Learning Collaborative

Supporting social, emotional, and communication development in children.

OUR WHY

Contact Us

@ Town Center:
600 Independence Blvd
Virginia Beach, VA 23456

@ Autism Resource Center:
3509 Virginia Beach Blvd
Virginia Beach, VA 23452

M-F: 11:00am-7:00pm
Saturday: Closed
Sunday: Closed

info@socialbutterfliesclub.com
757-422-6342

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SAY HELLO!

Complete one of the forms below and our office manager will get back to you as soon as possible. Feel free to call our main office at 757-422-6342 to chat.

Schedule Information

Client Information- Pediatric ONLY (ages 2 1/2-17) *ADULT Clients, Please scroll to the form below for the Adult Intake Form

Child Information

Parent Information

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