Dear Parent(s) /Carer (s)
By completing and returning this form, it is understood that as a parent(s)/carer(s) you have read and understood the following terms and conditions. A copy of my GDPR privacy policy can be found under policy.
Please allow 10-15 minutes to complete this form. All four pages should be completed before submitting the form. You will need a direct contact email for the school SENDCo/Head of Learning.
Please read the following information carefully and refer to my GDPR policy for further details, which is found on my website:
Please complete the following information and return it as soon as possible. The form must be received to secure the appointment; dates cannot be held for more than 10 days. A confirmation email outlining all assessment details will be sent as soon as your form is received.
It is important that the information you provide is as detailed as possible (especially any previous assessments and developmental history) as it will help inform my assessment and the conclusions made. Information will also inform my written report.
If yes, and living separately, please ensure that you inform them of the assessment and provide them with the opportunity to contribute to the assessment and share the report.
If yes, please detail nature and amount of support. If support has varied each year, please list separately in each box/part.
If yes, please detail ALL assessments and/or reviews below, no matter how old eg, Educational Psychologist, Specialist Teachers, Speech Therapists, Physiotherapists, Optometrists, etc.
Please provide a copy of any report/s. If there are more than two agencies involved/reports then please post hard copies.
If your child has had more assessments then please detail in a separate email or in the additional information box at the end of the form.
Please provide as much information as you can about your child’s developmental history and ongoing skills.
Immediate family members, including any step siblings/half siblings:
Please give name, relationship to child and age of any siblings. Please also indicate if the family member lives at home with the child.
If there are more family members then please detail them in the additional information box at the end of the form.
Please attach:-
If you would like to send anything please send to:
Thank you for completing your form. I will send a confirmation email soon outlining the assessment details.
Kind regards,
Emily Vincent
Educational Psychologist
Having links to multi agencies allows me to easily signpost you to others when needed.