Contact us

We require some details from you in order to help you as best we can. Please complete the London or Melbourne form and be assured that your details will be kept safe and private with us. We look forward to getting to know you and your child, and providing you with the help that you need.

London

141b Kingston Road
South Wimbledon
SW19 1LJ
info@connectlit.com
075 2513 8808
Get directions

LONDON ENQUIRY FORM

I would like more information on:

Dyslexia Assessments

Specialist Literacy Tutoring

Speech and Language Assessments

Speech and Language Therapy

Magic Link Handwriting

Reason for referral:

YOUR DETAILS

Name

First Name

Last Name

Email

Phone

CHILD'S DETAILS

Name

First Name

Last Name

Date of Birth

School Year

Name of School

SESSION DETAILS

Are you able to attend sessions at the clinic? (141b Kingston Road, SW19 1LJ)

Yes

No

Preferred days and times for sessions:

FEEDBACK

How did you find out about our service?

If other, please describe:

ADDITIONAL COMMENTS OR QUESTIONS

Melbourne

melb@connectlit.com
0447 474 712

MELBOURNE ENQUIRY FORM

Reason for referral:

YOUR DETAILS

Name

First Name

Last Name

Home address

Email

Phone

CHILD'S DETAILS

Name

First Name

Last Name

Date of Birth

School Year

Name of School

AVAILABILITY

Preferred days and times for sessions

FEEDBACK

How did you find out about our service?

If other, please describe:

ADDITIONAL COMMENTS OR QUESTIONS