Adult Enquiry Form Prior to Consultation

If you are in the workplace, or unemployed and would like help with skill development please complete this form as fully as you can, it will help us to help you. The answers are entirely CONFIDENTIAL to Centre Staff and Professionals directly concerned with you.

 

If you find this form difficult to complete the Centre will help you.

Date of Birth *
Address
Order
Employer's Address
Order
Order
More information
  • Files must be less than 80 MB.
  • Allowed file types: txt doc docx jpeg png pdf zip.
More information
  • Files must be less than 80 MB.
  • Allowed file types: txt doc docx jpeg png pdf zip.

Important Notice

Whilst great care is taken in all matter, the Centre cannot accept liability or responsibility for any advice given by the professionals to whom the Centre refers the child/adult (assesse).

The Centre may, in its absolute discretion and after the appropriate permissions have been obtained, maintain, for its administrative purposes only, a confidential file of records relating to the assesse including a copy of this questionnaire and any reports. The centre is at liberty to destroy such files or to charge a reasonable sum to retrieve any such files that have been retained.

If you provide your e-mail address Dyslexia Nigeria may contact you periodically with information and news. Any e-mail sent by Dyslexia Nigeria will provide the option to be removed from the e-mail mailing list

Your completion of this questionnaire is your acknowledgement that you have read, understood and accept the terms of this notice and that you agree to The Centre maintaining a confidential file.

To book an appointment, please call 01-6327387 and 09025446486 or mail screening@dyslexianigeria.com

Training

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Our Contacts

30B2, Remi Fani-Kayode Street, GRA , Ikeja, Lagos, Nigeria.

+234 1 632 7387

info@dyslexianigeria.com

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