Child Assessment Booking Pack

Children (under 16 yrs)
Dyslexia Assessment
Booking Pack
Name of Child: ……………………………………………………………………..
Date of Birth and Age of Child: …………………………………………………
Clients wishing to book a diagnostic assessment:
Following the recent government announcements, our policy continues to be to keep our staff,
volunteers, suppliers, customers and supporters safe. Therefore, the BDA will not be scheduling
any face-to-face assessments until April 2021. We are currently scheduling for April 2021 onwards.
We apologise for any inconvenience and hope you understand that our priority has to be the
safety of our clients and assessors.
Please read the information sheet that accompanies this booking pack carefully as this will
provide important information about the type of assessments available, the assessment process
and what to expect, and answers to other frequently asked questions.
British Dyslexia Association, Unit 6a Bracknell Beeches, Old Bracknell Lane, Bracknell, RG12 7BW
Tel: 0333 405 4555 (select Option 2 for the Assessments Department), Email: assessments@bdadyslexia.org.uk
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The Assessment Booking Process:
Download an Assessment Booking Pack.

1
Complete the assessment booking form (Please indicate preference for a

2 Specialist Teacher or Psychologist assessment).
Complete the Assessor/Psychologist Locations form .

3
Complete Pre-Assessment Questionnaires (Parent and School).

4
Identify any dates that you are not available .

5
Complete payment details on our website. Please note we cannot book

6 assessments without all of the necessary documents being received.
Email all completed forms together to: assessments@bdadyslexia.org.uk

Please note: Any further supporting information sent via post will not be
7 returned - do not send original documents.
Payment details will required in order to process the booking.

8
You will receive confirmation of your appointment by email.

9
Attend the appointment.

10
You will receive your report approx. 15 working days after your assessment.
11
Post-assessment: If you require a post assessment consultation then please

contact us to arrange this. These are usually done by telephone and may incur
12 a charge.
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Child Diagnostic Assessment (pre-16)
Booking Form
Please complete this booking pack to book a diagnostic assessment for a child. Please
return the completed booking pack by email to: assessments@bdadyslexia.org.uk
Details of Booking
Name of Parent/Carer
Home Address:
Contact Telephone numbers:
Contact Email:
Name of Child:
Child's date of birth:
Please note we cannot assess
children under the age of 7 years.
Please indicate if the assessment is to be with a Specialist Teacher Assessor Tick Here
OR an Educational Psychologist:
(Please note the assessment will take from 2 hours and can be up to 4
hours)
Specialist Teacher Assessor £450.00 plus VAT @ 20% = £540.00
Educational Psychologist £600.00 plus VAT @ 20% = £720.00
Are there any dates that you are NOT available from April onwards? Y / N
If yes, please give details:
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I understand that on receipt of my booking pack containing the required completed documents,
BDA will contact me to agree an appointment date and time for the assessment.
I agree that the BDA reserve the right to charge a cancellation fee equivalent to 100% cost of the
assessment for assessments that are cancelled within 48 hours of the agreed assessment date.
Signature:
Name (print):
Date:
Please return this booking pack by email to assessments@bdadyslexia.org.uk to

enable us to check the details and contact an appropriate assessor.
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Terms and Conditions for Diagnostic Assessments
Booking a Diagnostic assessment:

 The BDA will act as liaison between the assessor and the client for the purposes of booking
the assessment.
 The BDA reserves the right to change the assessor allocated if the assessor should become
unavailable for any other reason.
 In order to book the assessment your personal information and the information contained
within the booking pack will be passed onto the assessor in order for them to carry out the
assessment.
Privacy Policy:
 The BDA is committed to protecting the privacy of individuals. Accordingly, all personal
data collected will be subject to our Privacy Policy. For more information please see our
website.
 Following the assessment and the compilation of the final assessment report all client
questionnaires, all raw data test sheets and all other personal data will be permanently
deleted/destroyed.
 Your final assessment report will be held by the BDA for 7 years [within your customer
record file]. During this time you will be able to ask for an electronic copy of the report
Please note there may be an administration charge for this. We would therefore strongly
recommend that you keep a copy of your report securely. After this time the BDA will not
be able to supply you with a copy of your report.
 Should you require a copy of your assessment report, your report to be permanently
deleted; or for changes/corrections made to it before this time; or to make a complaint,
please notify us at: assessments@bdadyslexia.org.uk
How your information will be used:

From time to time we may like to send you information about our own products and services that
you might be interested in, by post, telephone, email and SMS. We will not pass your information
on to any organisation external to the BDA. If you agree to being contacted in this way, please tick
the relevant boxes to indicate all of the means by which you would like to be contacted.
Post Phone Email SMS
The BDA is committed to protecting your personal data please see our Privacy Policy on our
website
If you need any further information please write to us at: assessments@bdadyslexia.org.uk
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Payment details:
 Payment must be received before a booking can be confirmed.
Cancellation policy:
 Cancellation by the Client or Main Contact
o All changes and cancellations must be notified in writing to:
assessments@bdadyslexia.org.uk.
o Cancellation charges will be applied as follows:
 Cancellation/reschedule within 14 days of a booked session = 50% of fee
due;
 Cancellation/reschedule within 48 hours of a booked session = 100% of fee
due.
 Cancellation by the BDA
o In the event that severe weather or any other emergency results in the cancellation
of a session, the BDA will endeavour to give clients a minimum of 24 hours’ notice*
and to reschedule the assessment
o *Please note that it is the client’s responsibility to provide the BDA with an
emergency contact number at which they will normally be available.
----------------------------------------------------------------------------------------------------------------------------------
I agree to abide by the terms and conditions as laid out above.
Name (print): Signature: Date:
Please return this booking pack by email to assessments@bdadyslexia.org.uk to enable us to

check the details and make provisional contact with the most appropriate assessor.
How did you hear about the BDA
Website BDA Helpline Email Hardcopy Flier social media

Recommendation Other please state ______________________________
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Areas our Assessors Cover
Please indicate your preferred location for your Specialist Teacher OR Psychologist assessment.
We have assessors who cover the following locations. Please note that psychologist assessments
are not available in all locations.
Assessor locations Specialist Teacher Psychologist

£540.00 (inc. VAT) £720.00 (inc. VAT)
Bedfordshire
Berkshire
Bristol
Buckinghamshire
Cambridgeshire
Cheshire
Coventry
Derbyshire
Devon
Essex
Hampshire
Herefordshire
Hertfordshire
Kent
Lancashire
Leeds
Leicestershire
London
Manchester
Merseyside
Middlesex
Norfolk
Northamptonshire
Nottinghamshire
Pontypool
Shropshire
Somerset
Suffolk
West Midlands
Worcestershire 11+
Wiltshire
Yorkshire
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Important information for Parents/Carers
Following recent changes to the Joint Council for Qualifications (JCQ) guidance for Access
Arrangements 2017/18 please be aware of the following:
If your child is in Year 9 or above and you require the assessment that you are booking with the
BDA to be used as part of an application for Exam Access Arrangements, usually GCSEs or A
Levels, e.g. extra time in exams, a reader or a scribe, etc. then it will be necessary for you to
contact your child’s school’s Special Educational Needs Coordinator (SENCO) prior to the
assessment as this is now a JCQ requirement.
“7.3.6 A privately commissioned assessment carried out without prior consultation with the centre
cannot be used to award access arrangements and cannot be used to process an application using
Access arrangements online.
The SENCO must complete at least a ‘skeleton’ Section A of Form 8 prior to the candidate being
assessed (Section C of Form 8).” JCQ - Adjustments for candidates with disabilities and learning
difficulties Access Arrangements and Reasonable Adjustments 2017/18
If you would prefer not to contact the SENCO or think that you might experience difficulties with
this then please do contact us to discuss your options and the implications of this prior to booking
an assessment.
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CONFIDENTIAL PRE-ASSESSMENT QUESTIONNAIRE
For children (Pre 16yrs)
To be completed by parent / carer
Please fully complete this section as this section only will be passed to the assessor.
Full Name of Child: Age:

Date of Birth: School Year:
Country of Birth: Date moved to
the UK:
Is the child adopted? Yes No Prefer not to say
How does the child Male Female Non-binary Prefer not to
identify themselves? say
Name of parent / carer
(please state title e.g.
Mr/Mrs/Ms/Miss)
Home address:
Contact Tel No: (mobile) (work)

Contact Email:
Health and Developmental History
Early Development
Did you experience any problems during the pregnancy and birth of your child? Yes No
lf yes, please provide further details:
Were all the normal developmental milestones reached e.g. walking, talking, Yes No
riding a bike?
lf no, please provide further details:
Has your child ever had any Speech and Language difficulties? Yes No
lf yes, please describe these difficulties (such as understanding the meaning of words, expressive
language, speech clarity, pronunciation, word finding difficulties and if they had any speech and
language therapy):
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Is there a history of ear infections, glue ear or grommets? Yes No
lf yes, please provide further details:
Vision and Visual Difficulties

In order to proceed with the assessment, your child MUST have a sight test within the last 6
months. In some cases, difficulties with reading are caused by visual difficulties that are not
related to learning. Therefore, if, having answered the questions below, you suspect there are
visual difficulties* you MUST discuss this at the eye test so that the Optician (Optometrist)
carrying out the eye test, can refer your child on to an Ophthalmologist for further
investigation, prior to the assessment.
*Visual difficulties should be investigated if you answered ‘always’ or ‘sometimes’ to several

questions.
Has your child had any history of visual difficulties / problems with sight / visual Yes No
impairment?
lf yes, provide further details:
Does your child wear glasses? Yes No

lf yes, provide details (i.e. for near work, watching tv etc) and ensure glasses are brought to the
assessment:
Has your child ever used coloured overlays / colour-tinted glasses? Yes No
If yes please provide the following information:

Who recommended them and why?
Did they help? If yes, in what way?
Does your child still use them? If not, why not?
Reading and Near Work Activity

Approximately how many hours per school day does your child
spend at a screen (phone, tablet, computer) etc?
Approximately how many additional hours per school day does your
child spend reading books, newspapers, comics or other paper-
based texts?
Has your child’s screen /reading /near work time increased recently?
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If so, by how much?
Section for parents/carers Never Rarely Sometimes Often Always

Does your child report headaches when they are reading?
Does your child report that reading makes their eyes feel sore,
gritty or watery?
Does your child report feeling tired or sleepy during or after
reading?
Have you noticed your child become restless, fidgety or
distracted when reading?
Have you noticed your child rubbing their eyes when they are
reading?
Have you noticed your child screwing up their eyes when
reading?
Have you noticed your child tilting their head to one side when
reading?
Have you noticed your child moving their eyes around or blinking
frequently when they are reading?
Have you noticed your child holding a paper or book very close
to their eyes when reading?
How often does your child use a marker or their finger to keep
their place when reading?
Have you noticed that your child frequently loses their place
when reading?
Have you noticed your child covering or closing one eye when
reading?
Section for child
When you read, do you see two of each word?
When you read, do the words you read look blurry (or fuzzy, or
unclear)?
When you are reading, do the words move on the page?
When your teachers ask you to copy something from a screen at
the front of the classroom, can you see what is written on the
screen?
ls your child’s hearing within normal limits? Yes No

lf no, please give details:
Is your child on any regular medication that may be relevant? Yes No

If yes please give details:
Family History
Have any family members experienced difficulties with spelling / Yes No

reading / learning?
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If yes, please indicate relationship to child and describe the difficulties:
Language and Linguistic History
Are any other languages spoken at home? Yes No

If yes, please provide further details including if English is the main language. If English is the
second language, are there difficulties in their first language?
Educational History
Did your child pass the Phonics Test? Yes No Unavailable

If yes was that at the end of year one or year two?
Has your child’s schooling been disrupted in any way? Yes No

If yes please provide more information:
Have any of your child’s teachers discussed any difficulties your Yes No
child is experiencing?
Has your child seen any other specialists (e.g. Educational Yes No
Psychologist, Advisory teacher etc)?
If yes please provide more information and provide copies of reports:
Has your child received any support or intervention in the past? Yes No
Current Situation
Current National Curriculum Levels (if appropriate)

English
Maths
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What are the particular difficulties currently exhibited in school?
Reading Slight Moderate Severe
Spelling Slight Moderate Severe
Writing Slight Moderate Severe
Mathematics Slight Moderate Severe
Sports and Games Slight Moderate Severe
Is there any specialist help currently given at school? Yes No

If yes, please give details, (e.g. Teaching Assistant support, extra time in exams, EHCP, specialist
tuition):
Is your child currently receiving any tuition outside of school? Yes No

If yes please give details of the support being received and how often:
Literacy
Please describe your child’s current strengths and difficulties with Literacy?
Does your child have difficulty recalling the alphabet or other known Yes No
sequences?
Numeracy
Please describe your child’s current strengths and difficulties with Numeracy?
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Does your child have difficulty telling the time? Yes No
Memory, Attention and Concentration
Does your child have difficulties with memory, attention and concentration? Yes No
If yes, please provide further details:
Speech, Oral Language, Communication and Social Skills
Are there any current difficulties with speech, oral language or communication? Yes No
Does your child have difficulties with social skills, behaviour, peer relationships Yes No
or emotional adjustment?
Does your child have difficulties with self-esteem and confidence? Yes No
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Organisational Skills
Does your child have good organisational skills? Yes No

If no, please provide further details:
Fine and Gross Motor Skills
Does your child have any difficulties with fine and gross motor skills e.g. body Yes No
awareness, movement and balance?
Does your child experience left/right confusion? Yes No

Strengths
Please provide information about your child’s strengths, what they are good at, hobbies they
enjoy etc:
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Any Other Information
Please use the space below to summarise your child’s difficulties and your particular concerns,
including your concerns about other potential Specific Learning Difficulties (SpLDs). If you do not
have enough room below then please add a separate sheet.
Signed: Print name:

Relationship to child: Dated:
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SCHOOL PRE-ASSESSMENT QUESTIONNAIRE
For children (Pre 16yrs)
To be completed by the School
An assessment is being carried out to clarify this child’s learning, emotional and/or behavioural needs.
Information from the current school will be very useful and help to provide a wider context in which to
place these needs. If this assessment is required to potentially be used as part of an application for exam
access arrangements, under JCQ regulations, then we would strongly advise that you discuss this with
the individual's school or college prior to the assessment. This is so that the school/college can supply
information about the individual's normal way of working within this environment which will ensure that
any recommendations for support in exams reflect this. Your support is therefore appreciated.
All information will be treated confidentially.
Child’s full name

School
Year group
Name of person completing
this form
Title (Mr/Mrs/Ms/Miss)
Role in School
Date form completed
School SENCO contact details
Parents’/guardians’ details for correspondence

Full Name(s)
Title (Mr/Mrs/Ms/Miss)
Relationship to child
Address
Postcode
Mobile number(s)
Email Address
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School Performance
Please provide details about the child’s National Curriculum attainments:

SATs / end of Key English Maths Science
Stage results
Key Stage 1
Key Stage 2
Key Stage 3
Did the child pass the Phonics Test? Y/N

If yes was that at the end of year one or year two?
Below Average Above Below Average Above

Average Average Average average
Speaking and Reading
listening accuracy
Humanities Reading
comprehension
PE Writing
Art Spelling
DT Maths
ICT Science
Other:
Please details any recent assessments including test names, dates and results:
Does the child have any difficulty with:

Planning and organising written Y / N
work?
Getting started with written Y / N
work?
Copying from the board? Y / N
Remembering instructions? Y / N
Is there a discrepancy between the child’s verbal ability and written work? Y / N
Is this child being monitored for Special Educational Needs? Y / N

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Is there an individual Education Plan (IEP)/Personalised Learning Plan Y / N
(PLP)?
Please detail any current support/provision this child is receiving:
Who gives this support (role in school)?

What type of support?
Length of session(s)?
Frequency of support (times per week)?
Please provide evidence/information of the child’s normal way of working and relevant
background information if this assessment may be used as evidence for exam access
arrangements.
Has this child been discussed/assessed/monitored by any external Y / N
agencies, e.g. Educational Psychologist, Behaviour support, Learning
support etc.
If YES, please give details:
If the child has an Educational Health and Care Plan, please attach a copy of the most recent
Annual Review or other relevant information
Literacy
Please describe the child’s current strengths and difficulties with Literacy:
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Numeracy
Please describe the child’s current strengths and difficulties with Numeracy:
Memory, Attention and Concentration
Does the child have difficulties with memory, attention and concentration? Yes No
Attitude to work – please tick/highlight all that apply:

Keen Distracts others
Independent Competent
Works well with help Slow
Distractible Lacks interest
Speech, Oral Language, Communication and Social Skills
Are there any current difficulties with speech, oral language or communication? Yes No
Does the child have difficulties with social skills, behaviour, peer relationships Yes No
or emotional adjustment?
Does the child have difficulties with self-esteem and confidence? Yes No
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Peer relationships – please tick/highlight all that apply:
Popular Withdrawn
Accepted Better with younger
children
Friendly Avoids others
Dominant Has one special friend
Organisational Skills
Does the child have good organisational skills? Yes No

If no, please provide further details:
Fine and Gross Motor Skills
Does the child have any difficulties with fine and gross motor skills e.g. body Yes No
awareness, movement and balance?
Strengths
Please provide information about the child’s strengths, what they are good at school and
what they enjoy doing:
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Any Other Information
Please provide any other information that would be useful for the assessor to know and what
your hope to get out of the assessment:
Signed: Print name:

Position in school: Dated:
Your questionnaire will remain the confidential property of the parents, so please return your
response to them.
Thank you for your support and co-operation
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Checklist of Information Required for Booking:
 Completed booking form

 Assessment locations – identified the preferred type and location
of assessment
 Completed questionnaire – Parent/Carer and School
 Payment method to be confirmed
 Please note we cannot process bookings without having received
all of the completed documentation
 Delays in returning documents/sending payment details will result
in a delay in booking the assessment.
 Email this completed booking pack to
assessments@bdadyslexia.org.uk
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Children (under 16 yrs)

Name of Child: ……………………………………………………………………..

Date of Birth and Age of Child: …………………………………………………

Clients wishing to book a diagnostic assessment:

Download an Assessment Booking Pack.

Complete the assessment booking form (Please indicate preference for a

Complete the Assessor/Psychologist Locations form .

Complete Pre-Assessment Questionnaires (Parent and School).

Identify any dates that you are not available .

Complete payment details on our website. Please note we cannot book

Email all completed forms together to: assessments@bdadyslexia.org.uk

Payment details will required in order to process the booking.

You will receive confirmation of your appointment by email.

Attend the appointment.

Post-assessment: If you require a post assessment consultation then please

Contact Telephone numbers:

Please return this booking pack by email to assessments@bdadyslexia.org.uk to

Booking a Diagnostic assessment:

How your information will be used:

Please return this booking pack by email to assessments@bdadyslexia.org.uk to enable us to

How did you hear about the BDA

Website BDA Helpline Email Hardcopy Flier social media

Assessor locations Specialist Teacher Psychologist

Full Name of Child: Age:

Contact Tel No: (mobile) (work)

Health and Developmental History

Vision and Visual Difficulties

*Visual difficulties should be investigated if you answered ‘always’ or ‘sometimes’ to several

Does your child wear glasses? Yes No

If yes please provide the following information:

Did they help? If yes, in what way?

Does your child still use them? If not, why not?

Reading and Near Work Activity

Section for parents/carers Never Rarely Sometimes Often Always

ls your child’s hearing within normal limits? Yes No

Is your child on any regular medication that may be relevant? Yes No

Have any family members experienced difficulties with spelling / Yes No

Language and Linguistic History

Are any other languages spoken at home? Yes No

Did your child pass the Phonics Test? Yes No Unavailable

Has your child’s schooling been disrupted in any way? Yes No

Current National Curriculum Levels (if appropriate)

Is there any specialist help currently given at school? Yes No

Is your child currently receiving any tuition outside of school? Yes No

Memory, Attention and Concentration

Speech, Oral Language, Communication and Social Skills

Does your child have good organisational skills? Yes No

Fine and Gross Motor Skills

Does your child experience left/right confusion? Yes No

Signed: Print name:

Child’s full name

Parents’/guardians’ details for correspondence

Please provide details about the child’s National Curriculum attainments:

Did the child pass the Phonics Test? Y/N

Below Average Above Below Average Above

Does the child have any difficulty with:

Is this child being monitored for Special Educational Needs? Y / N

Who gives this support (role in school)?

Memory, Attention and Concentration

Attitude to work – please tick/highlight all that apply:

Speech, Oral Language, Communication and Social Skills

Does the child have good organisational skills? Yes No

Fine and Gross Motor Skills