Parent/carer Questionnaire for Dyslexia Diagnostic Assessment
Please fill in this form and submit it at least 7 working days before your assessment. Press the ‘Submit Form’ at the bottom of this page when you’re ready to send.
Your answers will help me to write a comprehensive diagnostic report considering a full picture of your child’s strengths and needs. Please also email copies of any reports from previous assessments, speech and language assessments, occupational therapy reports and individual education plans .
If you need help filling in the form, you can contact me by text/phone on 07947 733 179 or email millainetutor@gmail.com.
After the assessment face-to-face meeting, a full report will be written within 3 weeks.
Some of the questions may seem unrelated to a dyslexia assessment but they enable me to gain a full picture of your child’s needs and to assess whether referral to another professional may be appropriate.
Please read my privacy policy carefully – it explains how I use and store your information. Tick the boxes on the form to confirm you’ve understood.
PRIVACY POLICY
• Millaine Cornish takes your privacy seriously.
• All information given will be kept confidential and stored securely.
• All information given and reports written will be stored securely for 6 years after the report has been written. After this date any reports, diagnostic assessments or documents written will not be kept by the assessor and shredded.
• Confidential diagnostic reports will only be shared with people or institutions specified by the client for specifically stated purposes.
• Diagnostic reports sent by email to client will be password protected and locked for editing.
• It is the client’s responsibility to keep an electronic and a paper copy of a diagnostic assessment and any other documents issued to them by Millaine Cornish if needed for future use.
• The client is the person named as parent or guardian of the child being assessed, at the time of the report being written.