Consult session for SEN intervention needs

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

This form aims to find out more about you / your child's needs before contacting you for a complimentary consultation. The information will help us to assess your suitability for our SEN programmes, and to be referred for alternative supports.

Please note that this complimentary session is offered on a needs basis. It is not an intervention session, but an opportunity to understand more about SEN intervention for coping and expression. Kindly fill in this form if you are genuinely seeking therapeutic support.

For research or interest based inquiries, please email admin@actingupsingapore.com. Thank you!

My name is... (this will be kept confidential) *

This consult is for... *

Myself

My child

Other:

Age range (based on the question above) *

Child (2 - 6 years)

Child (7 - 12 years)

Adolescent (13 - 19 years)

Young adult (20 - 35 years)

Adult (36 - 60 years)

Senior adult (above 60 years)

I am seeking... *

SEN intervention support for myself / my child

More information for educational purposes

To gain knowledge

To gain career insights

Other:

Please tick the statements that are relevant for you. This will remain confidential and for our therapist's reference only. *

I am diagnosed with an SEN condition

I am seeking academic intervention for me/my child

I suspect I (or my child) may have an SEN condition, however I am not yet diagnosed

I am seeking coping methods

I am seeking social skills training for SEN needs

I would like SEN support, however I am unsure of my options

I would like to explore alternative forms of SEN intervention

I am / my child is currently on medication for an SEN condition

I am currently seeing a mental health professional for support (e.g. psychologist, psychiatrist)

Other:

Required

When do you hope to begin intervention sessions? *

Would you prefer individual or group intervention? *

Individual

Small group

I am / my child is willing to engage in SEN intervention support *

Strongly disagree

Disagree

Neutral

Agree

Strongly agree

Not applicable

I am willing / have ability to pay for intervention sessions *

Yes

If your answer to the above question is 'No', kindly share your reasons.

I understand that the complimentary consult is not an intervention session, and there will be no follow-up unless intervention sessions are engaged *

Yes

Required

Please provide 3 preferred dates and times for the consult, starting 22 Jan 2021. *

Please include me in Acting Up's mailing list to be updated on upcoming events, workshops and therapy sessions *

Yes

Any other information you'd like us to know?

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of actingupsingapore.com. Report Abuse

Forms