Assessment Enquiry Form

Thank you for contacting The Middle Path Psychology Group about an assessment.

Please complete the questions below. This information will help us understand what type of assessment you are looking for and whether we can assist.

After you submit this form, a psychologist will review your information and contact you by phone or email.

Person To Be Assessed

Please provide the details of the person who will be having the assessment. If the person is under 18: Please enter the child’s details below. For the email address and mobile number, please enter the contact details of their parent or carer.

First Name *

Last Name *

Age (of the person to be assessed) *

Residential Address *

Email Address *

Mobile Number *

Referrer Details

If a GP, paediatrician, psychiatrist, psychologist, school, lawyer or another professional recommended the assessment, please provide their details below.

Referrer Full Name

Clinic or Organisation of the Referrer

Referrer Phone Number

Referrer Email Address

Background Information

What assessment are you looking for? *

Autism assessmentADHD assessmentAutism & ADHD assessmentCognitive (intellectual) assessmentMental health/diagnostic assessmentPersonality assessmentParenting capacity assessmentCourt report assessmentOther/not sure

Why are you seeking an assessment? (Please briefly tell us about the main concerns or reasons for seeking an assessment) *

Has the person to be assessed previously been diagnosed with any mental health, developmental or neurodevelopmental conditions? (If yes, please list any diagnoses you know about)

Who is this assessment report intended for? *

MyselfParent / CarerPsychiatristPaediatricianGPNDISSchoolUniversityCourt/LawyerOther

If you selected Other, please write who it is intended for

If there anything else you would like us to know, please add these details below:

After you submit this form, a psychologist will review your enquiry and contact you by phone or email.

If you have any previous assessment reports or other relevant documents, you can email them to info@themiddlepath.com.au. Please include the name of the person to be assessed.

Submitting this form does not book an appointment. We will contact you first to discuss the assessment enquiry and next steps.

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