EHCP Form -

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hello@childrenswellnesscentre.co.uk
020 8061 9947
07494 200394

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About Us
Assessments
Therapies
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Gallery
Testimonials
Contact

EHCP Form

EHCP Form

Newsletter

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Please spend a few moments filling in the below form detailing a little more about your child and your goals for the consultation/s. Please click ‘submit’ once complete and this will be sent directly and confidentially to Rebecca, our EHCP Consultant.

Name(s):

Email:

Phone number:

Postcode/borough:

Child's name:

Child's date of birth:

Please give a brief description of your child’s needs (Please tick all that apply)

General learning

Literacy

Numeracy

Communication

Behaviour

Physical

If physical, please provide more information here or write n/a

Other

Does your child have any medical issues:

What support is your child receiving in school?

Are there any agencies or support services involved?

Has your child had a formal diagnosis?

Do you have any reports (Please tick all that apply)

Educational Psychologist

Paediatrician

Speech and Language

Occupational therapy

No reports

Other (Please provide details)

Does the school support your application for an EHCP?

Have you previously applied for an EHCP?

If the application was refused was any reason given?

Is there any other information you would like to share?

What would you like to achieve from the session/s?

Terms & Conditions

I am aware that in some situations Rebecca may need to talk to other members of The Children’s Wellness Therapy team regarding information disclosed in the session

Unless Rebecca needs to share details with The Children’s Wellness Centre Therapy team, I am aware that all other information shared between myself and Rebecca will remain confidential, except where a safeguarding concern is disclosed

I am aware that Rebecca will adopt a client-led approach and will offer advice, support and options for next steps, but it is my responsibility to decide what is right for my child

I am aware that these sessions are tailored to support and guide me with the EHCP process, but in no way do they guarantee a successful application

I am aware that the Local Authorities will determine if my application is successful and The Children’s Wellness Centre EHCP consultant Rebecca has no say whatsoever over the outcome

I am aware that payment for each session is due in advance and I will be sent an email invoice for this

I am aware that should I need to cancel my session I need to give 24 hours’ notice, either by emailing Rebecca directly or the main desk at The Children’s Wellness Centre

I am aware that failure to give the sufficient notice of cancellation, will mean the full fee is still due

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I agree to the Children's Wellness Centre's Privacy Policy and to being contacted about services they provide.

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Ready to find out more?

If you have any questions, please don’t hesitate to get in touch.

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The Children's Wellness Centre 27a Fishers Lane Chiswick London W4 1RX
hello@childrenswellnesscentre.co.uk
020 8061 9947
WhatsApp: +44 7494 200 394

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