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Study Buddy Enquiry Form
If you are a parent who has a child who is struggling, please fill in this form. All information received will be treated with the utmost confidentiality in line with current UK GDPR regulations.
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* Indicates required question
Email
*
Your email
Your name
*
Your answer
Are you contacting us about your son/daughter as their legal guardian?
*
Yes
No
What's the name of the child?
*
Your answer
What's their current age?
*
Your answer
Describe to us in summary what your child (or you) are struggling with in relation to their learning/school at the moment?
*
Your answer
Is there anything else your child struggles with in relation to school more generally?
*
Your answer
Which elements does your child find challenging (that affect his or her day to day life or wellbeing?
*
Socialising
Reading
Concentration
Physical Activity
Busy Social Situations
Communicating with others
Remaining on one task for longer than 30 minutes
Going to school
Getting started with homework
Behaviour generally
Writing
Required
What have you or your child already tried to support or resolve these difficulties so far to date?
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Your answer
Have you received any help from any other professionals either in school or outside of school
*
Your answer
If yes, did this help and how?
Your answer
Would you potentially like an online appointment or a face to face appointment in our clinic? (If we feel we can help then we will contact you to let you know our charges and to book the next available appointment)
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Online
Face to Face in Clinic (Location is near Stratford Upon Avon)
Other:
Do you know what sort of help your child needs?
Your answer
Please provide us with your email address and phone number so we can contact you following the review of this form
*
Your answer
Send me a copy of my responses.
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