Register for THRIVE 6

TheMotivation's 12-week family wellness programme.

Your details

Full nameMobile numberEmailPasswordPreferred languageRelationship to childReferred by (agent's full name, exactly as per their NRIC)

Needed before you can subscribe — this is who arranges your supplement delivery.

Send me operational messages (appointment reminders, safety notices). Required.Send me marketing messages. Optional, kept separate from programme consent.

Your child

Child nameDate of birthSex recordedSchool / learning setting

Diagnosis / developmental concerns (parent-reported)

ADHD (inattentive) ADHD (hyperactive-impulsive) ADHD (combined) Autism spectrum Anxiety Sleep disorder Other developmental concern None diagnosed

Current medicines (include ADHD medicine)Other supplements currently takenAllergies

Current therapies / support

Occupational therapy Speech therapy Psychology / counselling Educational support Physiotherapy None currently

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