Request an assessment

Once you have completed the 'request an assessment form' below we will contact you to request you complete a more in depth questionnaire.  We also need to see recent reports on your child written by their school, local Teacher of the Deaf, Audiologist, Speech and Language Therapist and Educational Psychologist. You may decide to post these to us or scan and attach them to an e-mail. We will then come back to you with an assessment date. If you would like to discuss anything with us before completing the questionnaire please contact:

Frances McMenemy on 01635 573820

Or email: f.mcmenemy@burwoodcentre.org

First Name:
Last Name:
Email:
Address Line 1:
Address Line 2:
Town/City:
County:
Postcode:
Phone:
Child's First Name:
Child's Last Name:
Child's Age:
Preferred Contact Method: