Assessment Enquiry Form

Assessment Enquiry Form

Please complete this form (takes approx. 5 mins) to help us consider the next steps in your assessment process. If you would prefer to provide this information verbally, please let us know you would like a phone call instead.
Current availability

Are you seeking an in-person or Telehealth assessment?
Do you have a preferred assessor?
Contact details
Name

First NameLast Name
Date of birth

DayMonthYear
Date
Gender
Other details
Pronouns
Other
Preferred contact method
Phone number
Please enter a valid phone number.Format: (0400000000).
Email
example@example.com
Address

Street Address

Street Address Line 2

SuburbState

Post code
Assessment options

NeuroAffirm only offers assessment/diagnosis of Autism & ADHD for adults 18 years + and does not assess/diagnose other presentations eg learning disability, dyslexia, Intellectual Disability/cognitive functioning, personality disorders etc.
What assessment are you seeking?
Details if 'other'
Why are you seeking assessment at this time?
For example, to learn more about myself, to receive recommendations for support, to take to a psychiatrist, to use as evidence for required accommodations in the workplace/study place.
ADHD & Medication

A psychologist can provide an ADHD diagnosis but is not able to prescribe medication. In Australia, only psychiatrists and GPs can prescribe ADHD medication. If you are considering medication, it may be more cost-effective to see a psychiatrist or GP directly. You do not need to see a psychologist beforehand.
Only complete if you are enquiring about ADHD assessment.
NDIS Considerations

Autism assessments provide a diagnosis and identify the level of support required. While the assessment report may be used as part of an NDIS application, it may not, on its own, provide sufficient evidence to meet NDIS access requirements. Please ensure that this assessment aligns with your intended purpose, as it is your responsibility to determine whether it meets your individual needs.
Please indicate your understanding below:
Please select the option that applies to your circumstances:
Please indicate your understanding below:
Mental health history
Please indicate any mental health diagnoses you have received:
Other mental health concerns or details.
Neurodevelopmental differences or brain injury
Please indicate any of the following diagnoses you have received:
Details
Medical conditions or illness
Please list any medical conditions or illness.
Legal matters
Do you have any current legal matters in court? For example family law court, criminal matters.
If yes, please provide details:
Further information and questions
Is there any further information you would like to provide? Do you have any questions?
Existing reports or documents
Do you have any existing reports or documents relevant to the assessment you are seeking? For example, psychiatrist, psychologist, OT, speech and language therapy reports. Please upload any documents below as these will need to be considered before starting an assessment.

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How did you hear about NeuroAffirm Psychology?

Other
Newsletter option: would you like to be added to NeuroAffirm's mailing list to receive occassional newsletters, resources, and updates?
Privacy Collection Statement

NeuroAffirm Psychology values your privacy and complies with the Australian Privacy Act 1988 (Cth). We collect personal information, such as your name, email, and message, when you submit our contact form. This information is used to respond to enquiries and provide support. By submitting the form, you agree to this collection statement.
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Assessment Enquiry Form

Current availability

Contact details

Assessment options

NDIS Considerations

Mental health history

Neurodevelopmental differences or brain injury

Medical conditions or illness

Legal matters

Further information and questions

Existing reports or documents

Privacy Collection Statement