Professional Development Enquiry
Hi there! Thank you for requesting The Neurodivergent Dentist as a speaker for your organisation. To assist with curating a PD to meet your needs, we'd love to collect a bit more information about what you're after.
Main Contact
*
First Name
Last Name
Pronouns
Please Select
she/her
he/him
they/them
she/they
he/they
other
Please specify pronouns if not in the list above
Email Address
*
example@example.com
Contact Number
*
Please enter a valid phone number.
Tell me a bit about your organisation, including those attending the PD session:
*
Prompts: Profession of audience members, specific settings where you practice and who you support etc.
Tell me a bit about the training your organisation has received regarding neurodiversity affirming practices.
Prompts: Have you had any experience with this topic before? What would be your preference regarding this session - introductory content, advanced, or somewhere in the middle?
What would you like to get out of this presentation as learning outcomes?
Prompts: aims/goals and values of your organisation and for this PD
Did you have specific topics in mind or focus areas that you'd prefer were covered?
*
Prompts: introduction to neurodiversity affirming practice in oral healthcare, supporting neurodivergent students and/or staff, integrating trauma-informed clinical approaches, effectively utilising social stories, accomodating sensory sensitivities in the dental setting, neurodiversity affirming oral hygiene instructions, making your entire practice accessible (from website to waiting room and more).
What date and time work best for you?
Any other specific dates and/or times, if the above selection is not suitable.
Please feel free to write as many options as needed. Open to discussion based on calendar.
Duration of PD Session
1 hour
1.5 hours
2 hours
Half Day Workshop (3-4 hours)
Full Day Workshop (9am - 4pm)
Other
Is there anything else that you feel is important for us to know?
Thank you so much for taking the time to fill out this form!
We will review your responses and put together a quote based on preparation time for the PD, delivery time and travel to and from (if applicable).
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