SPELD VICTORIA ASSESSMENT BOOKING AND ENQUIRY FORM - 2021
SPELD VICTORIA - ASSESSMENT BOOKING AND ENQUIRY FORM

Last Updated – JULY 2021
**
PLEASE NOTE - DUE TO HIGH DEMAND, PROCESSING TIMES ARE SLIGHTLY LONGER THAN NORMAL.
REST ASSURED THAT YOU WILL BE CONTACTED SOON. THANK YOU.
**

1 WEEK REPLY FROM APPLICATION

Due to high demand for our Assessment services, the first available appointment currently

*** taking bookings for 2022 ***

please proceed with completing the booking form if you would like us to proceed from this date.

We are hoping to hire more staff once COVID-19 restrictions allow us to,
until then we are unable to have more people in our office with current guidelines.

If you would like to make a booking for a consultation with a Psychologist / Book for an assessment, please complete the following questionnaire, and our friendly Administration Support Officer will be in touch as soon as possible.


1. Please complete the following questions.

2. Please click the submit button (orange) on the bottom of the form

3. A copy of your responses will be emailed to you.

4. You will be contacted via email first regarding your enquiry below.
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Email *
Your Full Name *
Your Best Contact Phone Number *
Your Full Postal Address *
Your Enquiry To Us *
Required
For a child assessment, does your child *
Child or Adult Full Name - To Be Assessed *
Date of Birth - DAY / MONTH/ YEAR *
Child's Grade / Year Level in School
Presenting Learning Difficulties of Child or Adult - To Be Assessed *
Required
Has The Child / Adult To Be Assessed Completed An IQ / Cognitive Assessment In The Last Two Years: *
Best Day Of The Week And Time to Contact You. *
Referred To SPELD Vic by *
Required
Any Further Comments
Thank You. Please Press The Submit button In Order For Us To Receive Your Enquiry. A copy of your responses will be emailed to you. You will be contacted via email first regarding your enquiry.
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