Well Said Clinic - Waitlist

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Welcome to the Well Said Clinic Waitlist

Thank you for your interest in accessing Speech Pathology services at Well Said Clinic.

Ongoing Speech Pathologist Sessions:
WAITLIST OPEN - Appointments from 9am to 3pm ONLY
WAITLIST CLOSED - Afterschool & Saturdays

Our friendly and experienced team of Speech Pathologists is passionate about delivering high-quality, client-centred care to individuals and families. All of our Speech Pathologists are mentored by an experienced clinician with over 45 years of expertise in the field.

Head to our website www.wellsaidclinic.com.au to see details of all our staff.

If you would like to join the waitlist, please kindly complete the form below. The more details you provide, the better we’ll be able to align your child with the most suitable Speech Pathologist.

If you have any questions, don’t hesitate to contact us on 1300 773 324.

First & Last name the Child: *

Child's Date Of Birth
*

YYYY

Male or Female
*

Male

Female

Agender

Nonbinary

Transgender

Gender Fluid

Another Term (Please Specify)

Do you require an interpreter? *

Yes

Is the child Aboriginal or of Torres Strait Islander origin?
*

Yes

Language (s) spoken at home, if yes, what language?

Parent/Guardian First & Last Name
*

Parent/Guardian Relationship to Child
*

Parent/Guardian Phone Number:
*

Parent/Guardian Email Address
*

Preferred Availability for Appointments eg. days/times
*

How are you funded to access Well Said Clinic? *

Privately funded

Medicare (Care Plan)

Private Health Insurance

National Disability Insurance Scheme (NDIS)

Does your child currently see a Speech Pathologist?
*

Yes

Has your child been recently assessed by a Speech Pathologist in the last 12months
*

Has your child had any relevant diagnosis?
*

Autism

ADHD

Global development delay

Down syndrome

Cerebral palsy

Hearing impairment

Vison impairment

Mental health diagnosis - please specify

Genetic condition - please specify

Physical Condition - please specify

Currently undergoing diagnostic assessment

Selective Mutism

Childhood Apraxia of Speech

Specific Learning Disorder

Social Communication Disorder

No diagnosis

Please specify below:

If Autism is diagnosed, please specify what level or specify none *

Please provide a reason as to why the child requires Speech Therapy?
*

Please advise if your child is using single words, short phrases, or full sentences. If your child is non-verbal, please indicate this and provide any other methods they use to communicate (e.g., gestures, sign language, communication devices, pictures, etc.).
*

Do you think your child would be able to take part in therapy sessions delivered via TeleHealth (video calls)? *

Yes, my child could join independently

Yes, with support from a parent/carer

No, TeleHealth would not be suitable at this time – we would prefer face-to-face sessions in Clinic

Please provide any additional Information

Where did you hear about us? *

Word of Mouth

School / Kinder

Internet

Other

Thank you for filling out all the information above.

The Next steps:

Tarryn, our Practice Manager, will be in touch with you once an appointment becomes available.

Should you have any questions, please feel free to email info@wellsaidclinic.com.au or call 1300 773 324.

Please acknowledge you have read & understood all of the above information. *

Yes

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