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Child intelligence (IQ) testing at our Canberra office

Email: info@canberrachildtesting.com.au

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Child's details

Child's name*

Child's age*

Child's school grade*

Child's gender:

Child's date of birth:

DD slash MM slash YYYY

Reasons for seeking testing

Please describe reasons for seeking testing

Specific reason for testing:*

IQ/Cognitive ability

Academic ability

Giftedness

ADHD/Inattention

Learning difficulty

Emotional/Behavioural concerns

Memory concerns

Opportunity Class/Selective School application

School readiness

None of the above

Select all of the above that apply

Have you been referred by a medical specialist (e.g., paediatrician/psychiatrist) to our service?

Yes

No

If yes, please indicate any specific tests they have requested you to complete as part of the referral to our service (e.g., Conners 4, CBRS, WISCV, WIATIII)

Parent's details

Parent's name*

Phone Number - Mobile only please*

(Leave out 0 as it will auto-populate)

Email Address*

Enter Email Confirm Email

Marital status*

Other parent's name*

Other parent's mobile phone number*

Other parent's email address*

Important note: For all child assessments, if parents are separated or have joint legal custody, as psychologists under our APS professional code we require written consent from both parents to proceed with the assessment. The exception to this is if there is a risk to the child by involving the non-presenting parent or family court orders advise against this. Assessment correspondence (e.g., appointment info, child history taking, assessment questionnaires, and the final report) will only be sent to the parent who first initiated contact with the service, unless requested otherwise.

Child's teachers details (Optional)

To prepare for the assessment please include below your child's teachers name and email address and advise them you have given permission for Canberra Child Testing to contact them directly to include teacher feedback in the assessment (Note: We only contact teachers with parent consent. The teacher should ideally have known your child for at least 3 months).

Child's teachers name

Child's teachers email address

Enter Email Confirm Email

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Belconnen, Canberra

For all enquiries please use our Contact us enquiry form. We will get back to you within 24-48 hours of your enquiry.

For urgent queries, please SMS 0485 864 413 and we will call you back asap or call our Sydney office: (02) 9418 6062

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