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個案登記表 - 智力、讀寫障礙、專注力及自閉症評估 Case registration : IQ, SLD, AD, Autism and HKCAS-P
為了可以儘快為 閣下提供服務安排,請化數分鐘填寫以下問題。
Please fill in the form to facilitate our service matching and arrangement
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* Indicates required question
1. 姓名 Name:
*
Your answer
2. 聯絡電話 Contact number:
Your answer
3.方便聯絡的時間:
Convenience time for contact
*
Your answer
4. 服務類別需要:
Type of Service Need
*
智力評估 Intelligence quotient
讀寫障礙評估 Study & Learning Disability (SLD)
專注力評估 Attention Deficit (AD)
自閉症行為觀察及評估 Autism
香港學前兒童綜合發展量表 Hong Kong Comprehensive Assessment Scales for Preschool Children (HKCAS-P)
Required
5. 學童姓名:
Name of Student
Your answer
6. 年級:Class:
Your answer
7. 出生年/月/日 Date of Birth: Y/M/D
MM
/
DD
/
YYYY
8. 學校種類:
Type of School
國際學校 International School
本地學校 Local School
Clear selection
9.請列出你對學童的關注點,及學校老師的意見:
Please elaborate your concern on the child and teacher's comment
*
Your answer
10. 選擇會面的地點:
*
中區堅道二號明愛大廈 2, Caritas House, Caine Road, Central.
荃灣城門道九號明愛服務中心 9 Shing Mun Road, Tsuen Wan Caritas Social Service Centre
9. 會面時段
Time of Interview
*
服務時間 (星期一至五 上午9時 至 12時30分 及 下午1時30分 至 5時正)
Office hour (Mon. - Fri. 9:00 - 12:30 & 13:30 - 17:00)
特別服務時間︰(香港) 星期二及五 下午5時 至 8 時正 ; 星期六 上午9時 至 下午5時正
Non-office hour (HK- Tuesday & Fri. 17:00 - 20:00; Sat. 9:00 - 17:00)
Non-office hour (TW- Wed. & Fri. 17:00 - 20:00; Sat. 9:00 - 17:00)
特別服務時間︰(荃灣) 星期三及五 下午5時 至 8 時正 ; 星期六 上午9時 至 下午5時正
Other:
Required
10. 其他特別需要/要求:
Special request:
Your answer
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