Mainstream Review Assessment Booking Form

The agreed review assessment date will be held for 2 weeks; this booking is only confirmed on receipt of this FULLY completed form and deposit payment (£300 plus £5 Stripe administration fee). If after two weeks this form has not been completed the date will be given to the next person on the waiting list. If you are unable to complete this form and make payment, for whatever reason, please contact Caro on to discuss.

By completing this form, it is understood that as this child/young person’s parent/guardian or as the commissioning adult you have read, understood and agreed to the following terms and conditions about the forthcoming review.

Please find our GDPR policy on the website.

It is also understood that by completing this form you are giving us permission to contact school/college/workplace for information about the child/young person/adult’s progress unless we have discussed otherwise. If you have any queries, please do not hesitate to contact Sonja on or Caro on

Please allow 15-20 minutes to process and complete this form, it must be completed in its entirety, it cannot be saved and returned to.

TERMS AND CONDITIONS

The Process:

1. Either myself, Caro Strover-Green or a CSGA Associate Educational Psychologist or one of our trained Assistant Psychologists will be allocated to the review, guided most of all by ‘fit’. An Assistant Psychologist is an honours psychology graduate who we have trained and closely supervise. They are British Psychology Society affiliated with a role that is formally recognised within the profession https://www.bps.org.uk/assistant-psychologist-job-profile. These roles are important as a pre cursor for their doctorate programme. We supervise closely from planning through to the report so effectively you have two psychologists attending to the assessment.
2. The commissioning parent/adult needs to check that the school/college/workplace/home  can provide a quiet working space with a table and chairs for the morning of the review assessment on the allocated date. If not, then please get back to us before completing this form, so we can organise another date.
3. Please email to any professional reports that have been completed since our initial assessment.  This will help plan the review as well as contribute to it.
4. In order for the assessment to take place, parental/guardian consent must be provided.  It is up to this consenting parent/guardian/commissioning adult to make any others with parental responsibility aware that the review is taking place, so that they may also contribute to the process if they wish. Each person with parental responsibility will have a right to see the subsequent report on request.
5. It is best practice to gain school/college/workplace/educatiional therapist/tutor’s views about this child/young person/adult’s progress, and the detail of any support that they have been receiving.  To this end, agreement to these terms assumes that, unless otherwise discussed, you are giving permission for us to liaise with this child/young person/adult’s school/college/workplace  to request their perspective and further information.
6. By  signing this agreement commissioning parent/adult is giving permission that we can contact any professionals that have been involved since the initial assessment, if further information is required.
7. Feedback on the assessment is offered in a zoom call following receipt of the review report, at a mutually convenient time for us, parent/guardian/commissioning adult, and school/college/workplace, or any other professional who may be involved and where it is relevant that they attend.

 The report:

• Details of the review will be provided in a written report which is usually sent within 14 days of the assessment.

The child/young person’s involvement in the assessment:

• It is very important to hear the child/young person’s views about their learning and this is an important part of any session.
• Prior to the review, please let your child know that we are visiting to see how they are getting on, since our last session. If they have any anxiety about this, please let us know as we can arrange a zoom call for a day or so before the review, to talk them through what it is about.
• If this child/young person would like to know more about what an educational psychologist does, they are welcome to refer to the website www.edpsych.co.uk

Fees

• The charge for the review assessment plus any additions are listed below. Please look at the options and select to show if you would like the assessment to cover any extras. It might be that on preparing, we suggest some changes.
• The deposit is nonrefundable, and minus the Stripe £5 fee, will be deducted from the final bill.
• Note there is a one-off service charge of £100 as outlined in the booking terms and conditions.
• The fee covers: the time it takes to prepare the assessment/review, the assessment/review session, feedback and the report with recommendations.
• If there is no communication or prior agreement, interest will be applied to the invoice at 2% per month pro rata if the invoice is not paid  within 7 days of the invoice being emailed to the client.

Not included

• The fee does not cover international telephone calls which will be charged extra if necessary.
• The fee does not cover parking costs which will be added, at cost, if necessary.
• When the journey is over 40 minutes each way from Marlborough, there is a charge of £50.
• If the assessment is split over 2 visits, a service charge of £50 is added to cover travel and administration.
• Any additional assessment reports since the previous assessment e.g. previous optometrist, speech and language, occupational therapy or private tutor reports, are important to process so please email these to us.  These will be charged at pro rata basis of an additional £25 per report (dependent on the length of the report) with a charge of £75 for multiple reports.  This will also include any further relevant communication between the professional and us. Please email copies of these reports to when you return this form.

Cancellation:

• If the Assessment is cancelled after the preparation has commenced or within 24 hours of the booking, a cancellation fee may be charged to cover the time spent in preparation, and to cover the loss of revenue if it is not possible to use the cancelled date for other work.

Payment terms:

• If there are financial difficulties, please contact us to discuss any possible reductions and/or payment options.
• The report is only released on completion of payment.
• Balance payment by internet transfer is preferred, and bank details are given on the final invoice.
• The deposit minus the £5 Stripe fee, are deducted from the final bill

Data processing and storage – in compliance with the General Data Protection Regulation (GDPR) (Regulation (EU) 2016/679

Please read the following information carefully:

• The final report for the Review and any other information will be stored on Cliniko, for 5 years, which is secure and meets GDPR standards (for the purpose of reference, in the case of a request for future re-assessment, input or on request by parent/guardian for a copy if their copy has been lost).
• During the time of the assessment process, information will also be stored on the working laptops which are all password protected.
• Practitioners are ICO registered.
• Copies of the report are confidential and emailed to the parent/guardian/commissioning adult (and other authorised parents or family) as a pdf document, password protected in line with GDPR, unless otherwise requested by you. School/College will also be copied into the same email, unless specifically requested otherwise.
• Booking forms, reports and any questionnaires are stored using Cliniko software which is secure encrypted software.
• You can request that other professionals who are involved with supporting this child/young person/adult can also receive a copy of the report.
• Any hard copies of reports, background information forms, assessment booklets and notes will be destroyed shortly after the review.  All necessary information will be recorded in the full report or stored in Cliniko.