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Contact Form

As an alternative to completing this questionnaire you can also call us on 1850 200 321

From the following checklist please select any of the symptoms you feel might be affecting your child:
Reading difficulties
Poor spelling
Writing problems
Poor at ball games
Difficulty learning to ride a bicycle
Problem tying shoe laces
Difficulty learning to blow nose
Difficulty learning to swim
Problem learning to skip
Attention Deficit Disorder
Low self esteem
Anxiety/panic attacks
Travel sickness
Concentration problem
Poor organisation and planning
Difficulty establishing and retaining friends
Messy eating or spilling when pouring
Losing or forgetting books/sports gear
Short Attention Span
Difficulty with rote learning
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Enter your name:
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Email address:

Enter your postal address
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Enter your Telephone Number:
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Name of child:

Age of child?

In school what class is the child in?
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Has the child been diagnosed with any condition?
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(If yes, please specify)

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Enter further relevant details regarding your child:

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