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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Your Full Name
Your Best Contact Phone Number
Your Full Postal Address
Your Enquiry To Us
Full Assessment ( Everything - Consultation , assessments, , feedback, report )
Partial Assessment for a child ( if child has completed an IQ - cognitive assessment in the last two years)
Literacy Assessment for a child ( if child has not received additional support in school or out of school)
Assessment for an Adult
For a child assessment, does your child
Have a diagnosed disability (e.g. Autism, ADHD, OCD etc)?
Have NDIS funding?
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
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
Allied Health Professional
Word Of Mouth
Social Media - Facebook
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.
A copy of your responses will be emailed to the address you provided.
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