Saltroad Screener
(Our Speech Therapy services are rated 5 stars by parents on
Trustpilot
)
1. How concerned are you about your child's speech problems?
1 = NOT Concerned / 10 = EXTREMELY Concerned
1
2
3
4
5
6
7
8
9
10
2. Which age bracket does your child fall into?
Pick an option
Under 2 years old
2 - 2.5 years old
2.5 - 3 years old
3 - 3.5 years old
3.5 - 4 years old
4 - 4.5 years old
4.5 - 5 years old
5 - 5.5 years old
5.5 - 6 years old
Over 6 years old
3. Which of these best describes your current situation?
Select as many as appropriate.
I've just recently noticed, for the first time, some issues with my child's speech
I've been aware for some time that my child has a speech problem(s), but I'm worried it's not getting better (or getting worse)
Someone else has recently pointed out issues with my child's speech
I'm currently waiting to see an NHS Speech Therapist
My child has been turned down for NHS Speech & Language Therapy
I've been actively looking for a private Speech Therapist
I'm currently waiting to see a private Speech Therapist
My child has recently had a speech assessment
4. Does your child play well with other children?
Yes - My child mixes well with others
No - I think my child has some difficulties interacting with other children
I'm not sure
5. Does your child appear to understand language well?
Yes - My child understands language well & can follow instructions
No - I think my child struggles with this
I'm not sure
6. Does your child use words & sentences appropriate for their age?
Yes - My child can use words & sentences to have a conversation or tell me what they need
No - I think my child is behind with this
I'm not sure
7. Is your child's speech clear and easy to understand?
Yes - My child's speech is clear and developing well
No - I / other people struggle to understand what my child is saying
I'm not sure
8. Does your child have a stammer or stutter?
Yes
No
I'm not sure
9. Most importantly, please write a short description of your child's speech problems and/or your main concerns:
10. What is your relationship to the child to be assessed?
Pick an option
Parent
Grandparent
Foster Carer
Guardian
11. Please enter your Town / City:
This is to account for regional variations or accent
12. Please provide your email address:
We will use this to contact you with our advice and recommended on next steps
13. Finally, please provide us with your First Name?
This is simply for use in any communications with you.
By submitting this form, you confirm that you are the primary care giver and have legal authority to act on behalf of your child:
I Accept
I Do Not Accept
Submit Form