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* 1. What is the primary reason for seeking an assessment?

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* 2. Has your child previously been assessed by any specialists?

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* 3. Which specialists has your child worked with in the past? Select all that apply

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* 4. How would you describe your child's current academic performance?

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* 5. Is your child currently receiving any special education services?

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* 6. Please describe any specific concerns or areas where you seek guidance.

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* 7. What areas are you hoping to address with the assessment information? Select all that apply

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* 8. What is your preferred method of consultation?

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* 9. Parent/Guardian's full name (as on Passport/Driver's Licence

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* 11. Parent/Guardian's telephone number

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* 12. Parent/Guardian's address

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* 13. Are you over 18 and enquiring to have adult assessment?

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* 14. Are you the parent/guardian/carer of the child you will be discussing? guardian?

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* 15. How much does feeling unsure about how to communicate about your concerns prevent you from becoming more involved with your child's current school?

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* 16. Please add biographical information about the person/child we will be discussing e.g. age, gender, year/grade in school, qualifications, aspirations.

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