Child Form

General Information
Child's Name
Child's Name
School attendence has been:
Please provide details around your concerns and current issues. (e.g. learning; behaviour; social; communication; etc)
Parental Information
Please provide both parents names, contact details, occupations and addresses.
Guardian / Mother's & Father's Names
Guardian / Mother's & Father's Names
Postal Address
Postal Address
Health & History
Were there any concerns with hearing or vision?
example: diabetes, hearing aids...
example: anxiety
example: migrated to New Zealand : parents recently separated
Has the child had a previous assessment?
It is a legal requirement that both parents agree to their child's assessment ahead of it commencing.
If a report is required, which way(s) would you like to receive the report?