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COMPLETE ENROLMENT ENQUIRY FORM
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Menu
Home
Blog
Our Approach
Vision & Purpose
What is Neurodiversity?
What is inclusion?
What is the ESDM?
A Multi-Disciplinary Model
Research & Resources
Our Services
Autism Diagnostic Services
Intensive Early Intervention
Speech & Language Pathology
Occupational Therapy
Feeding Therapy
Parent Services
ESDM in Mainstream
Inclusion Coaching Program
NDIS Support
Fading Supports Over Time
Our Centres
Western Sydney
Northern Sydney
About Us
Our Story
Our Team
Video Gallery
Parent Testimonials
60 Seconds at the CDI
Contact Us
Learn More - Watch our Early Intervention Webinars
Testing
If you would like to enrol your child at the CDI, please proceed as follows:
1. Complete the form below and click Submit
2. You will then be re-directed to a detailed questionnaire which will help us identify the CDI programs most appropriate to your child's needs
Once we have reviewed your information our Intake Officer will give you a call to discuss your child's enrolment at the CDI in detail.
Please indicate which CDI centre you are enquiring for:
(Required)
Please select any option
Western Sydney (Northmead)
Northern Beaches (Beacon Hill)
Either
Name
First
Last
Email:
(Required)
Phone (enter your 10 digit mobile number):
(Required)
Suburb:
(Required)
Your Child's Name:
(Required)
Your Child's Age:
(Required)
Please select any option
0
1
2
3
4
5
6
7
8
Year your child was born:
(Required)
Please select any option
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
Month your child was born:
Please select any option
January
February
March
April
May
June
July
August
September
October
November
December
Select the statement below that best describes your child's diagnosis:
Please select any option
Diagnosed with ASD Level 1
Diagnosed with ASD Level 2 or 3
Diagnosis of Global Developmental Delay / Developmental Delay
No diagnosis
Other Diagnosis (please add details below)
If you have selected 'Other Diagnosis' above, please provide further details:
Does your child experience challenges with play skills & participation?(0-6)
Yes
No
Does your child experience challenges with speech or communication?(0-6)
Yes
No
Does your child experience challenges with speech or communication?(6-8)
Yes
No
Does your child experience challenges with specific motor skills eg. Handwriting, core strength?(0-6)
Yes
No
Does your child experience challenges with specific motor skills eg. Handwriting, core strength?(6-8)
Yes
No
Does your child experience challenges around mealtime and feeding?
(Required)
Yes
No
If applicable, when did your child receive their Diagnosis - enter approximate month and year:
MM slash DD slash YYYY
Please add any additional comments regarding why you are seeking early intervention for your child (optional):
If your child has a current NDIS plan, enter the approximate month and year of commencement:
MM slash DD slash YYYY
How is your child's NDIS plan managed?
Please select most relevant option
Self Managed
Plan Managed (Third Party manages your child's plan)
NDIA Managed / Agency Managed (This funding is not applicable to access CDI service)
No NDIS plan - have not applied
Waiting for first planning meeting or for first plan to commence
Would you like an obligation free phone call from our NDIS advocacy partners, Footprints Advocacy, to discuss accessing an intensive NDIS plan for your child?
Yes please (By ticking yes you are consenting to share your details with Footprints Advocacy)
No thanks, my child's NDIS plan is appropriate
How did you hear about us?
(Required)
Paediatrician / GP
Allied Health Professional
NDIS Co-ordinator
Social Media or Advertising
Mothers Group / Friend
Google Search
Other (please list below in comments)
Please provide the name or organisation if a specific person referred you:
Please add any other comments regarding your enrolment enquiry:
When you hit the submit button below you will be directed to another website to complete a pre-enrolment questionnaire. Your child's enrolment request is not completed until you have submitted the next questionnaire.
Got it, thanks
No thank you, I don't want to enrol my child at the CDI
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