To start the process, please fill out the contact form below.

Complete the details below about your child so that I can best meet you and your child's needs.

*Please note, there is approximately a three month wait time for assessments. Once I receive your form, I will be in touch with the next steps.

Name

First Name

Last Name

Phone

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Relationship to the Child

Child's Name

First Name

Last Name

Child's Birthdate

YYYY

Child's Current Age in Years

What preschool or school does your child attend:

Child's current school year level:

What are your concerns about your child?

Reading

Maths

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Behavior

Other

Does your child have any previous diagnosis? (please write 'none' if not applicable)

Please note anything else that you would like me to know about your child.

How did you hear about Unlock Psychology?

Word of Mouth

School Referral

Website / Google Search

Other

Or have questions?
I’m here to help.

Email
info@unlockpsychology.co.nz

Unlock your child's full potential today.

info@unlockpsychology.co.nz

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To start the process, please fill out the contact form below.

Or have questions?I’m here to help.

Or have questions?
I’m here to help.