Appointment Request Form

Parent Education Session

Appointment Request Form
Recent research and reforms on best clinical practices have identified a persistent gap in ADHD treatment - parent education. Bridging the most recent research findings and management in ADHD patients have indicated better outcomes and better wellbeing for ADHD/ neurodiverse individuals.

We are glad to offer this session with accessible fees for our patients to improve management of ADHD in evidence-based and practical strategies. Please fill in below to express interest.

Individiual sessions are 50 mins long, fee $110.

These sessions are not Medicare rebateable.
Child/ Patient Name*

First NameLast Name
Child's date of birth*

MonthDayYear
Date
Parent/ Carer Name*

First NameLast Name
If another parent/ carer is attending, please also include their name and relationship to child.
Contact Number*
Please enter a valid phone number.
Email Address*
example@example.com
Please pick date/ time *
Any other specific date and time, if the above selection is not suitable.

MonthDayYear
Date
Hour MinutesAM/PM Option
I would like to know more about (some topic suggestions)....

I want a clearer understanding of ADHD/ Autism and the causesI need some recommendations on how to recalibrate a ADHD-friendly home environment/ routinesI would like to understand how non-medication strategies can helpI am/ my child is feeling grief and not adjusting well to the diagnosis/ information about ADHDI want to know how ADHD can/is impacting my child's learning, functioning and relationshipsI am struggling to get my child to adhere to the treatment options given by my doctor.I'm struggling with screentime with my ADHD childMy partner is not on board with the diagnosis and treatment - how to advocate for my child with family members for best outcome.I would like understanding on the pharmacological mechanisms of ADHD medicationMy child has been untreated for a long time and I would like to know how to mitigate the "missed opportunities"Tools for emotional regulation, how to ensure mental wellbeing for my child and myselfOther
IMPORTANT NOTICE – NON-CLINICAL SERVICE DISCLAIMER*

I ACCEPT: [By engaging with the educational services provided by Jia Yong at SmartPaeds, you acknowledge and agree to the following: 1. Non-Clinical Nature of Services. The educational services provided—including but not limited to coaching, informational sessions, workshops, and written resources—are intended solely for general educational purposes. It is the parent/ carer's duty to determine if the information from the session is suitable for your family's needs. They do not constitute medical, psychological, psychiatric, or other professional healthcare advice, diagnosis, or treatment. 2. No Substitute for Professional Advice. The content and guidance provided during sessions should not be relied upon as a substitute for professional medical or mental health evaluation or care. If you are experiencing distress or symptoms that may require clinical attention, you are strongly encouraged to consult a licensed healthcare professional. 3. No Therapeutic Relationship. Your engagement in these services does not establish a doctor-patient, therapist-client, or any other clinical relationship. 4. Limitation of Liability. To the maximum extent permitted by law, the educator shall not be liable for any direct or indirect loss, injury, or damage arising from the use of, or reliance upon, the information provided in these educational services. 5. Jurisdiction. This disclaimer is governed by the laws of Western Australia, and any disputes will be handled under the jurisdiction of its courts. 6. No Medicare rebates apply. By participating in any educational session or accessing any materials, you confirm that you have read, understood, and accepted the terms above.]
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Parent Education Session