APPOINTMENT FORM

1. Name and surname of the child's parents/legal representative:

2. Phone:

3. Email

4. Name and surname of the child:

5. Date of birth of the child:

6. Previous examinations already completed (multiple options can be picked):

PPP STEP Another counceling center No examination

7. The child is currently visiting:

8. Class:

9. I request an on-site examination:

10. Difficulties:

11. A more detailed description of the difficulties:

12. I am asking for (multiple options can be picked):

Examination* Consultation Course*

13. Kind of examination (multiple options can be picked):

Comprehensive/individual education* School readiness* Premature school maturity* Special pedagogical* Psychological* Adaptation to entrance exams Professional orientation Homeschooling

14. Kind of consultation (multiple options can be picked):

Pedagogical Psychological Individual therapy Family therapy

15. Course (multiple options can be picked):

Preparatory course for children before school* Graphomotor course* Social skills training* Reeaducation* Development program for the support of attention and memory*

Receipt of the appointment form will be acknowledged by the employee within 3 working days.

* Service provided by VDS STEP experts, a partner organization of PPP STEP.

WHERE CAN YOU FIND US?

Pavlisova 2246
272 01 Kladno

DO YOU HAVE ANY QUESTIONS?

+420 602 590 000
ppp@ppporadna.cz

Facebook

Scroll Up