Child/Teen (17yo & under) Psychometric Assessment Enquiry Form

Location

Which clinic are you enquiring about?(Required)

Client Details

Client Name

First Name(Required)

Last Name(Required)

Date of Birth(Required)

Gender

What are the correct pronouns?

Address

Street Address(Required)

Address Line 2

Suburb(Required)

State(Required)

Postcode(Required)

School(Required)

Year(Required)

Parent / Guardian Details

Parent/Guardian 1

First Name(Required)

Last Name(Required)

Relationship to Client(Required)

Contact Number(Required)

Email Address(Required)

Parent/Guardian 2

First Name

Last Name

Relationship to Client

Contact Number

Email Address

Reason for Assessment

Select type of assessment
This information will help us find the best Psychologist for your child.

Select type of assessment(Required)

ADHD

Learning Concerns

Intelligence

Adaptive Functioning

Other

Additional information

Who has recommended an assessment for your child?(Required)

Has the client seen a psychologist before?(Required)

Yes

General Information

How did you hear about us(Required)

Policy

Cancellation - We ask that clients contact the clinic no later than 48 hrs before your appointment if you are unable to attend, please cancel at your earliest opportunity via phone, text or email so that the appointment can be made available to others. In the event you don’t, a cancellation fee will be incurred. This policy is explained during intake and at the initial appointment with your psychologist.

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Request Appointment

Castle Hill Clinic

02 9054 7830

info.CH@sydneypsychhub.com.au

Suite B, 8 McMullen Avenue,
Castle Hill, 2154 – Get directions

Longueville Clinic

02 8090 7880

info.LV@sydneypsychhub.com.au

Tenancy G-25, 4 Northwood Road,
Longueville, NSW 2066 – Get directions