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Sydney Speech Clinic Group Program Enquiry Form
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* Indicates required question
Parents Full Name
*
Your answer
Your Phone Number
*
Your answer
Your Email Address
*
Your answer
Full name of your child
*
Your answer
Child's Date of Birth
*
MM
/
DD
/
YYYY
Are you an existing client of the clinic?
*
Yes
No - Attending therapy services elsewhere
No - Not attending any other therapy services at the moment
Is your child an NDIS participant?
*
Yes
No
Which Group Programs are you interested in?
*
Term 3: 9-12 year olds Social Group Program - Thursdays 4.30pm -5.30pm
Term 3: Teens Social Group Program - Mondays 4.30pm - 5.30pm
Term 3: Teens Social Group Program - Thursdays 4.30pm - 5.30pm
Term 3: School Readiness Group Program - Thursdays 9.30am - 10.30am
Term 4: 9-12 year olds Social Group Program - Thursdays 4.30pm - 5.30pm
Term 4: Teens Social Group Program - Mondays 4.30pm - 5.30pm
Term 4: School Readiness Group Program - Day TBC
July School Holidays: Lego Based Therapy Group Program (Week 1 - 4th, 5th, 6th July 9.30am -11.30am)
July School Holidays: Lego Based Therapy Group Program (Week 2 - 11th, 12th, 13th July 9.30am - 11.30am)
July School Holidays: Literacy Group Program OR 1:1 Intensive (possible dates can be discussed)
July School Holidays: Teens Social Squad (Week 2 - 11th, 12th, 13th July - 3.30pm - 5.30pm)
Register Interest for Future: 7-9 year olds Social Program
Register Interest for Future: Parent and Toddler Program
Register Interest for Future: Happy Hands OT Program
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