Assessments Intake Form | NALA

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Assessments Intake Form

Thank you for your interest in our psychological assessment services.

We currently don’t have capacity for new assessment intakes until mid-July 2024.

We apologise for any inconvenience this may cause. In the meantime, we recommend discussing alternative options with your GP or the professional who referred you. They may be able to connect you with other assessment clinics in your area.

We plan to open our books for new assessments again in mid-July. Please check back with our website then or contact us to inquire about availability.

We appreciate your understanding.

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Client Details

Client Name(Required)

First Name Last Name

Date of Birth(Required)

Who is this assessment for?(Required)

Preferred Contact Number(Required)

Email(Required)

Parent / Guardian Details

Please be aware that if there is a custody arrangement in place both parents consent is required for the sessions to go ahead. If the second parent's consent is unable to be obtained please call us to discuss options.

Parent / Guardian Name(Required)

First Name Last Name

Preferred Contact Number(Required)

Email(Required)

Type of Assessment

Type of Assessment(Required)

ADHD

Learning Concerns

ASD

Cognitive/Intelligence

Not sure

Additional Information

Please include as much detail as possible.

General Information

Referred by(Required)

Cancellation Policy

We understand that there may be times that you will need to cancel or reschedule your appointment. We will do our best to reschedule or swap an appointment time however this may be difficult at late notice. To change or cancel an assessment appointment you must make the request no later than 48 hours before your consultation. In the event that you do not request a cancellation within the cancellation period or do not attend your scheduled consultation time, you will forfeit the full deposit of $250 paid on booking.