Report Request Form

Report Request Form
Client Name*

First NameLast Name
Who is requesting this report?*

First NameLast Name
If you would like a copy of your completed report request form, please add you email address here:
example@example.com
Which Clinicians Are Required To Write This Report:*

Speech PathologistOccupational TherapistDevelopmental Educator
Speech Pathologist*
Occupational Therapist*
Developmental Educator*
Please note there is a 3 week turnaround time for reports. During peak periods this turnaround time may exceed 3 weeks. Your clinician will contact you if this is the case.
Reason for report

To help my child’s school/kinder/childcare understand my childPaediatrician/specialist reviewNDIS access request formNDIS planning/review meeting (routine)NDIS early review request (RORD or Change of circumstances)AHA therapy planAssessment reportOther
Report type*

Summary Report (under 1 page)Short Report (2-3 pages)Comprehensive Speech Pathology ReportComprehensive Occupational Therapy ReportMultidisciplinary Report (Speech Pathology and Occupational Therapy)AHA Therapy PlanHome ProgramPlease write the best report possible for the reason provided
Assessment report type*

Certificate of assessment only (no fee)Short Report (2-3 pages)Comprehensive Report (recommended for diagnostic purposes)AHA/ therapy planOther
I would like to request a rushed report

I would like to request a rushed report as ideally I require this report within 21 working days. I understand this request cannot always be accommodated and my clinician will contact me to discuss if this is not possible. Report writing for rushed reports is charged at $228 per hour to accommodate the overtime payments required to complete these reports by their due dates. This rate is above the NDIS fee schedule, and as such you will incur out of pocket costs if you are using NDIS plan or agency managed funds.
Where should we forward your account?*

Directly to me (client)Plan ManagerNominated representativePlease charge my nominated card that is stored on file
If you would like to pay by credit card, please call us with your credit card details, or complete and return our Credit Card Authorisation form.

Please email me your Credit Card Authorisation form
Is there anything else you need us to know about your request?
I am aware that report writing is charged at standard clinical rates as per the current Talkativity Fee Schedule. I understand I am responsible for the cost of writing this report.
Reports will only be released following payment, or suitable payment arrangements confirmed. Please contact our team at hello@talkativity.com.au or (03) 5941 9852 if you require more information.
I would like a feedback session to discuss the details of this report.

Please contact me to book a feedback session
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