Expression of Interest: '7 Strategies' Carolyn's 1:1 Coaching Program

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Welcome to the 7 Strategies Program! This program is based on Carolyn's book 'A Parent's Guide To Early Communication' (December 2023):

Please complete this short questionnaire to express your interest.

1. Carolyn's '7 Strategies' Program

This is an upcoming 1:1 parent coaching package based on Carolyn's upcoming book 'A Parent's Guide To Early Communication'. Carolyn has limited places for this package of 7 individual sessions based on each strategy from the book. It is aimed at using the most powerful strategies to make a difference now. This program is designed for both Allistic or Autistic children. Carolyn has limited spaces for this program.

If you complete and submit this form, you'll be contacted by Carolyn Webb, Speech and Language Therapist CORU Reg. SL 015115 when a space becomes available. You can book in for one consultation first, then you'll have the option to continue with the remaining 6 sessions.

The Speech Grove SLT Service reserves the right to change services offered.

PLEASE NOTE: BY COMPLETING AND SUBMITTING THIS ONLINE FORM, YOU ARE CONSENTING THAT YOUR INFORMATION BE USED FOR THE PURPOSES OF ORGANISING UPCOMING PARENT PROGRAMS, AND AGREE TO BE CONTACTED BY CAROLYN WEBB, SPEECH AND LANGUAGE THERAPIST IN THE FUTURE REGARDING OTHER PRODUCTS AND SERVICES. YOUR INFORMATION WILL NEVER BE SHARED WITH A 3RD PARTY WITHOUT YOUR SIGNED CONSENT.

Parent / guardian names (Please include mother's maiden name) *

My child's full name *

My child's date of birth *

YYYY

Best email address(es) (you may wish to give both parent's email addresses to receive program information and forms) *

Best contact telephone (you may wish to give both parents' numbers here) *

Address *

My child's main challenges are... (Click on all that apply) *

My child is not interacting with others very much, is independent and prefers to play alone

My child is sensitive to certain sounds or sensations

My child likes to play with toys in their own way e.g. lining things up or examining objects closely

My child seeks movement a lot

My child may understand some things but tends not to respond to my voice, or when I call him/her.

My child understands much of what I say but doesn't use a lot of language

My child is good at letting me know what s/he wants using eye contact, sounds and gestures but isn't using a lot of language

My child plays with only a few toys or else prefers people play (tickles/chasing) without any toys

My child is using a lot of language but finds it challenging to use correct grammar

My child is using a lot of language but finds it challenging to have to and fro conversations

My child mainly communicates with me by bringing things to me or pulling me to things

My child enjoys showing me things of interest but doesn't use language yet

Other:

Required

My child has been diagnosed with *

Autism

Down's Syndrome

Language needs (by a Speech and Language Therapist)

Speech sound difficulties, replacing certain sounds with others or leaving sounds out (by a Speech and Language Therapist)

No diagnosis yet but is on a waiting list for multi-disciplinary assessment for autism

No diagnosis yet but I am waiting to see a professional to find out what the best next steps are

No diagnosis but I believe my child's only challenges lie in the areas of language understanding and using language

A hearing impairment

Global Developmental challenges

I think my child has Social Communication challenges or challenges interacting with others

Other:

Required

Please explain what you would hope to gain from this service *

Where did you hear about The Speech Grove service? *

Online advertising

Online Search

Word of Mouth

AVISTA, BLAKESTOWN CDNT: Your submitting this form indicates your agreement for Carolyn to share your name and your child's name with Avista Blakestown CDNT

Little Moo Moo's (if you heard about us here, Carolyn may liaise with this service)

Other:

Required

Thank you for completing this form! Carolyn will contact you as soon as possible.

You can contact Carolyn directly at thespeechgrove@gmail.com if you have any further questions in the meantime

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