Worried About Your Child's Development?
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Get guidance from out friendly specialist.

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✦ Fields marked with * must be filled in before submitting.

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Section A Your Details (Parent / Guardian)

Your Full Name *

Your WhatsApp Number *

+60

Start with your country code. Example for Malaysia: 601X-XXXXXXX

Your Email Address *

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Section B About Your Child

Child's Full Name *

Child's Date of Birth *

Child's Gender *

Boy

Girl

Has your child received any diagnosis? *

Speech Delay

Autism / ASD

Learning Difficulty

Developmental Delay

Not diagnosed yet

Not sure

It's okay if you're unsure — we can guide you.

What Are You Worried About? *

There’s no right or wrong answer, just share what you’ve noticed 💛

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Section C What Kind of Help Are You Looking For?

What type of support are you interested in?*

Why Are You Contacting Us Today? *

Get programme information

Book a trial session

Schedule a consultation

Request a developmental assessment

Just exploring options

Please select your preferred day.*

Weekday

Saturday

Flexible

Please select your preferred time.*

Morning (8am – 11am)

Afternoon (11am – 3pm)

Evening (3pm onwards)

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Section D How Did You Find Idzmir Kids Hub?

Where Did You Hear About Idzmir Kids Hub? *

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Who Sent You Here? (Optional)

Please tell us more *

I agree to let Idzmir Kids Hub use my information to contact me about their programmes, registration, and follow-up. I understand my details are kept private and will only be used for this purpose.

🔒 Your info is safe with us. We'll reach out within 24 hours.

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Worried About Your Child's Development?We're Here to Help 💛

Worried About Your Child's Development?
We're Here to Help 💛