Request for Screener

Parents Name * Required

Parents Email * Required

Phone * Required

Address

Client / Child's Name * Required

Birthday

School

School Year

Please list any medical conditions, disabilities including allergies the student may have.

Please confirm that eyes have been tested within the previous 12 months. * Required

Is there any other information that you think we should be aware of?

Why are you requesting this screening? * Required

Please screen for the following * Required

Note: current price is £100 for either dyslexia or dyscalculia screening or £150 for both conditions.

I agree to the terms and conditions which have been provided. * Required

I understand that a screening is intended to indicate whether an individual might benefit from a full diagnostic investigation into dyslexia and / or dyscalculia or not. It is not a diagnosis of a specific learning difference.

The screening will be carried out out by a qualified specialist teacher/assessor holding an Assessment Practising Certificate (APC) issued by PATOSS.

I agree to pay a non-refundable fee upon booking, prior to attending for the screening.

Should the recommendation be to conduct a full diagnostic investigation then if this is undertaken within 6 months of this screening then 50% of the fee for this screening will be deducted from the fee for the diagnostic investigation.

Data is kept electronically. Only the data needed to complete the assessment and / or tuition is kept. Anonymised data may be used for academic purposes. Data will not be passed onto third parties without express written instructions and will be destroyed within 12 months of no longer being a client of SpLD Assessment (subsidiary of Southampton Tuition Centre).

https://spldassessment.com/specialist-assessment-terms-and-conditions/

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