Child Questionnaire

Was the birth at full term and a normal delivery:

Yes

Were all the normal development milestones reached? E.g. Walking, talking, riding a bike?

Yes

Has your child ever had any Speech and language difficulties?

Yes

Is there a history of ear infections, glue ear or grommets?

Yes

SCHOOL HISTORY

Current National Curriculum Levels (if appropriate)

What are the particular difficulties exhibited in school?

BACKGROUND INFORMATION

Is hearing within normal limits?

Yes

If NO, please give details of problem:

Are they on any regular medication that may be relevant?

Yes

Are any other languages spoken at home? Please indicate:

Have any other family members experienced difficulties with spelling/reading/learning?

Yes

If YES please indicate relationship to assessee:

Please summarise any difficulties and your particular concerns. Please include any information which you feel may be relevant, such as school reports or any information from the SENCo and submit with the Booking Form.

TERMS & CONDITIONS

Signing and returning the Booking Form secures your date/place - Payment of invoice is due in advance by BACS in advance. A separate invoice with banking details and will be sent to the email on the Booking Form. I am afraid I cannot accept personal cheques.

For INSET sessions a copy of the presentation will emailed in advance with any handouts to be photocopied by the school ( preferably on non white paper).

If there are over 50 attendees the trainer will need to be notified in advance.

For assessments the report will be returned within 15 working days but will be retained if payment is not made.

CANCELLATION CHARGES

1. If you are unable to go ahead with the training/assessments, you must advise Positive Dyslexia as soon as possible, at least 48 hours in advance.

2. Positive Dyslexia will endeavour to rearrange the date to a mutually convenient time.

DATA PROTECTION ACT 2018

The information you provide on this form will be used by Positive Dyslexia to process your booking request. From time to time we would also like to send you information about our other services.

CHILD CONFIDENTIAL QUESTIONNAIRE

PERSONAL DETAILS

DEVELOPMENT HISTORY

SCHOOL HISTORY

BACKGROUND INFORMATION

TERMS & CONDITIONS

CANCELLATION CHARGES

DATA PROTECTION ACT 2018

KEEP UP WITH OUR LATEST NEWS