Bramhall Speech and Language Therapy

Questionnaire

Is this the right service for you?

This short questionnaire will enable you to decide if we can offer you help which is appropriate to your child ’s needs.

Bramhall Speech and Language Therapy offers assessment and consultation for children with speech and language problems, communication and interaction problems related to the autistic continuum conditions as well as speech and fluency problems. At present we cannot offer assessment for children with other types of developmental problem. Please use the checklist below to ensure that we can offer you an appropriate service for your child ’s needs.

You can print out the questionnaire below by clicking the Print Preview link below then use your browser's Print menu option to print the form. Tick the appropriate boxes and include your name, address and a telephone number and send the completed form to the address on the form. (You can return to this page by clicking the title at the top of the Preview page). Thank you.

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Services we can offer

If you answer yes to one or more of the questions below then a speech and language therapist may be able to help

	YES	NO
Are you concerned about your child’s listening and concentration?
Are you concerned about your child’s ability to relate to others or play with peers?
Are you concerned about your child’s speech intelligibility?
Are you concerned about your child’s ability to understand spoken language?
Are you concerned about your child’s ability to speak in sentences?
Do you have concerns about your child’s play?
Do you have concerns about your child’s reading and writing?
Are you concerned that your child’s not talking yet?
Do you have difficulty understanding your child’s speech?
Does your child have non-fluent speech which is beginning to cause concern?
Does your child talk inappropriately about unrelated subjects?
Do you find it difficult to have a conversation with your school-aged child?
Does your child have difficulty making friendships?
Does your child repeat your speech or phrases from videos and TV without understanding?

Services we do not offer

We do not offer services for children with significant developmental problems other than communication problems. If you answer yes to one or more of the questions below, it is likely that your child may need to be seen by a different sort of professional.

	YES	NO
Are you concerned about your child’s general development?
Do you have concerns about your child’s co-ordination?
Does your child have difficulty with fine movements?
Are you concerned about your child’s behaviour in general?
Does your child have a hearing impairment?
Does your child have a visual impairment?
Do you have concerns about your child’s progress at school?
Do you have concerns about relationships with your child in general?
Has your child been referred to other professionals?

If you have answered yes to one or more of the above questions then your child’s difficulties lie outside of the communication domain and we recommend that you seek further information about potential sources of support by contacting one of the organisations on the LINKS page