Referral Officer’s Assessment Form - SPELD NSW

Supporting children and adults with specific learning difficulties

Referral Officer’s Assessment Form

Referral Officer

MM slash DD slash YYYY

Contact Details

Reasons for Assessment

Information About the Person Being Assessed

Person being assessed date of birth

Previous Testing / Diagnosis

Previous Assessments


Has the person being assessed received intervention in these areas?
Has the client been advised by SPELD NSW that 6 months of intervention is required in the area of difficulty for diagnosis
If the client is a school aged child and they have not had six months of intervention, the appropriate assessment is generally an Educational Assessment. If the client is an adult and they have not had intervention they can still completed the psycho-educational assessment as the psychologist can consider other diagnostic criteria.
Has the parent been advised that diagnosis is unlikely to attract individual school based funding?

Testing Preference

Assessment Type(Required)
Would the client like an ADHD assessment added to a Psycho-educational Assessment?
The Educational Assessments are a new assessment type for SPELD NSW. They only include the Educational testing and DO NOT include a Cognitive Assessment. Students CANNOT get a diagnosis from an Educational Assessment. Educational Assessments are appropriate for students who haven’t had the 6 months intervention to help determine the specific areas of difficulty. Clients can come back after completing an Educational Assessment and after completing targeted intervention to complete a Diagnostic Review in order to be assessed for a diagnosis.
Test Preference(Required)
The SPELD NSW Clinic would prefer clients in Sydney complete a Face to Face Assessment. Online Assessment is available to clients in regional and rural areas and clients in Sydney who have disability or illness that makes it difficult to attend the SPELD NSW Office.

Next Steps to start booking process

If client wants to proceed with assessment:(Required)
If the client wants to proceed with a booking with SPELD NSW please submit this form and then create a task in MemNet allocated to Heather (Admin) to book an assessment.
This field is for validation purposes and should be left unchanged.
Scroll to Top