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Let’s Get Started with a Free Phone or Online Video Consultation

Please fill out the expression of interest form to include as much information as possible.

Leonie or her secretary will then offer the option to book in a 15min phone call or video call free of charge.

Expression of Interest Form

Child Information

First Name

Last Name

Date of Birth

Gender

School Name

How did you hear about Small Talk SALT?

Parent Information

First Name

Last Name

Phone Number

Address

Address Line 1

Address Line 2

City

Post Code

Please outline your concern's regarding your child's communication

What are the main social concerns that you feel may need some support?

Does your child have any specific learning difficulties or neurodevelopmental differences? (e.g. dyslexia, ADHD, ASC)

Has nursery/school commented or shared your concerns?

Secure storage

Any personal information given is stored securely and confidentially. It is used in a safe and ethical manner in line with the EU General Data Protection Regulation (GDPR), 2018. It is not shared with other people without prior consent.

Right to access

A copy of the personal information given can be requested in an electronic or paper format. Factual information can be amended if incorrect.

Do you agree with your personal information being collected, stored and used.

I agree

Feel free to also email with inquiries at leonie@smalltalksalt.com

Book a free 15 min call

Child Information

Parent Information

Secure storage

Right to access

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