Workplace Needs Assessment Enquiry Form

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* 1. Name:

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* 2. Email:

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* 3. Contact number:

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* 4. Organisation:

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* 5. How many employees do you have?

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* 6. How many dyslexic employees do you have that you know of?

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* 7. Has the employee been diagnosed as dyslexic?

Yes

No

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* 8. When are you looking to book this assessment?

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* 9. Have any recommendations already been put in place for the dyslexic employee?

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* 10. Anything else you would like to add?