Speech Pathology Application

Speech Pathology Application
What you need to know

Our speech pathologists work on a range of communication needs.

We focus on language (ability to understand and use language), articulation (speech sounds), social skills and literacy.

We support students struggling to develop appropriate reading and spelling skills, with effective high-quality intervention using the Sounds-Write program.

Your application will be reviewed and we will contact you to advise available times and to book your first appointment.

Speech Pathology Fees

Please click here for more information.
Parent/Adult Applicant Details
Parent Name/Adult Applicant

First NameLast Name
Contact Phone Number

Area CodePhone Number
Email
example@example.com
Address

Street Address

Street Address Line 2

SuburbState

Post CodeCountry
Student's Details
Student's Name

First NameLast Name
Date of Birth

DayMonthYear
Date
Current School
(for adults provide last school attended)
Year Level at School
(for adults provide year level achieved)
Areas of Difficulty

Please provide a brief description about the difficulties your child is having in any of the following areas:
Hearing.
Receptive language (ability to understand language)
Expressive language (ability to use language)
Speech sounds
Social communication
Reading
Spelling
Other areas of concern.
Please provide any professional assessment information here if applicable
Preferred location:
Preferred day
First preference
Second preference
Are you open to other days/times if your preferred day/time is not available?
Please indicate how your child’s speech pathology services will be funded.
If plan-managed, please provide your plan manager details. For other option, please provide billing details for invoicing purposes.
If your child has a NDIS plan, please provide the start date and end date listed below

MonthDayYear
Date
NDIS plan end date

MonthDayYear
Date
Are you open to other days/times if your preferred day/time is not available?
How did you hear about the Speech Pathology Services?

Other
Submit Form

To submit the form online, you will need to enter the Captcha word below and then click the SUBMIT button. You will receive an email copy of the information you have provided for your records.
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