Waitlist sign-up form
Thank you for seeking support for you or your child.

Unfortunately, at this time we have a waitlist to manage demand for our services. We review our waitlist each month between Feb and November and aim to communicate updates to everyone waiting about time estimates.

From time to time, we can also offer 1-3 sessions to those waiting for ongoing services as a way to provide some initial support and allow you the opportunity to see if we are a good fit for your needs.

At that time, we will ask for additional consent and more detailed information.

If you experience technical difficulties or you prefer a non-electronic method, please email the director at shannon@inclusive-communication.co.nz and request a paper version. Y
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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