€120,00 EUR

Is this consultation for the parent or school?

Child's Name

Child's Date of Birth

Child's Gender

What class is your child in? (Up an update on education)

What is your main concern for your child at the moment?

2nd Parent's Name:

2nd Parent's Email

2nd Parent's Phone Number

In the case of separated parents, I confirm that both parents consent to this appointment.YESNOThis is complicated - I will email you to explain on [email protected]

I give consent for myself and/or my child to participate in healthcare services as appropriate with EPT Clinic. I understand that this involves giving consent for personal and sensitive data to be held and used as described in EPT Clinic's GDPR policy.I consent

I understand that EPT Clinic is a recognised training clinic and as such, trainee professionals and students are part of our team.I understand

Have you have attended EPT (remotely or in person) before?YesNo

Is there anything else you wish us to know?

Signiture:

25 Minute Psychology Telephone Consultation with Psychologist Lorraine Madden 💚

Speak with Lorraine for 20-25 minutes to access a brief assessment screening phone call, and access signposting to the next step for you and your family.

What you'll get:

Support and guidance straight away
Brief screening for neurodivergence
Pathway guidance

Please note, this is not a full assessment and guidance will be based on best - practice and clinical judgement.