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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1. 姓名 Name: *
2. 聯絡電話 Contact number:
3.方便聯絡的時間:
Convenience time for contact
*
4.  服務類別需要:
Type of Service Need
*
Required
5. 學童姓名:
Name of Student
6. 年級:Class:
7. 出生年/月/日 Date of Birth: Y/M/D
MM
/
DD
/
YYYY
8. 學校種類:
Type of 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
*
10. 選擇會面的地點: *
9. 會面時段
Time of Interview
*
Required
10. 其他特別需要/要求:
Special request: 
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