Swanbourne School Program Permission Form — Kat’s Speech Pathology

Swanbourne Primary School - School Based Program

Kat’s Speech Pathology is pleased to be partnering with Swanbourne Primary School to offer Speech Pathology screening to children from Kindergarten to Pre-Primary, to identify speech and language difficulties as early as possible. We are also happy to offer school based speech and language assessments for Year 1 to Year 6 students, for this age group these would be comprehensive assessments to evaluate all areas of your child’s speech, language and literacy. To request an appointment for assessment or screening of your child, please fill out the form below. We will then email you an appointment confirmation email as soon as the screening or assessment has been scheduled.

Parent's Name

First Name

Last Name

Child's Name

First Name

Last Name

Child's Date of Birth

Email

Phone

Year level of your child

Teacher's Email Address

Funding

Private Health

Medicare Chronic Disease Management Plan/Team Care Arrangement

Self Funded

NDIS Self Managed

NDIS Plan Managed

Do you have concerns about your child's communication skills? If so, what are they?

Days your child attends school (if in Kindergarten)