Waitlist sign-up form
We are currently running a waitlist. We aim to contact people on our list every term with an update. From time to time, there are cancellations and we may be able to book you in for an initial consultation.  

Ngā mihi nui,
Shannon Hennig

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Your name: *
Client name: *
Client's year of birth: *
Your location (e.g., Petone, Kilbirnie, Aotea, Wainuiomata, etc.): *
Best contact number:
Email: *
What are you hoping we can help with?
Any other details you would like us to know at this time (e,g., accessibility needs, cultural considerations, or other details of how we can best connect with you):
Privacy Statement
Privacy statement - We are gathering this information so that we can gauge if we are an appropriate service for your needs and so that we can contact you.  We provide our services in the community, so it helps us to plan how to assist by knowing the clients general location and age.

We take privacy seriously. We store all personal data securely and you have the right to contact us to request access to your data or make corrections at any time.  For more information about our policies, please refer to www.inclusive-communication.co.nz/policies 

By subitting this form, we assume you are giving us permisison to contact you about speech-language therapy services.
Would you like to hear about our workshops and other opportunities for support while you wait for an individualised ongoing service?
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