Waitlist Questionnaire for Speech Pathology

Waitlist Form for Speech Pathology Services
We want to thank you for taking the time to complete our waitlist questionnaire. Your detailed responses are appreciated as it assists us in finding the right services for clients as quickly as we can.

Please note that HDAH speech pathology services are currently at capacity. You will be added to our waitlist and contacted by email monthly to confirm your continued interest. We cannot guarantee how long it will take for a service to be found in our practice; however, we actively manage our list to ensure that we move as quickly as possible.

By filling out this form, you will not be guaranteed an appointment with us. This form helps us find a service to meet your specific needs and manage your position on the waitlist more efficiently.

If you no longer require our services, please let us know by contacting us at admin@hdah.com.au.

Contact & Background Information
Client's Information*
Parent/ Guardian One*
Parent/ Guardian Two
Primary Email Address*
example@example.com
Residential Suburb*

Funding Type
Please select the appropriate funding*

MedicareNDIS self managedPrivate health insuranceNDIS plan managedNo funding
Additional comments regarding funding.
i.e. waiting on NDIS approval

Client Availability

Please select the following days & times that you are available for an appointment. These days and times may change when booking an appointment.

	Morning (7:30am - 10:30am)	Daytime (10:30am - 3:00pm)	Afternoon (3:30 - 6:30pm)	Full availability
Monday
Tuesday
Wednesday
Thursday
Friday

Any other notes regarding client availability
The more flexible you are, the more easily we will be able to allocate you an appointment time. After school appointments tend to be more desired, therefore more difficult to get in. We reccomend if your child can be seen during school hours, your therapy will be expedited. We cannot guarantee that you get your desired time, as it depends on the availability of our Speech Pathologists.