Parent Education Session Request Form

Each child and family have unique sets of strengths and challenges, these parent-only sessions are tailored to help with understanding the psychology and neuroscience behind specific behaviours, as well as strategies that can improve family and relational dynamics and functioning.

We are glad to offer sessions for parents have support in management of ADHD in evidence-based and practical strategies. Please fill in below for booking request - bookings are confirmed via clinic.

Individiual sessions are 50 mins long, fee $120. These sessions are not Medicare rebateable.

Child/ Patient Name

First NameLast Name

Child's date of birth

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.Format: 0000 000 000.

Email Address

example@example.com

Please pick date/ time

Any other specific date and time, if the above selection is not suitable.

Date

Hour MinutesAM/PM Option

I would like to know more about (some topic suggestions)....

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.]