Skip to content
CALL ACM ON 02 9482 8099
Speech Therapy Services
Book Now
Contact Us
Book Now
Contact Us
Facebook
Instagram
Home
About
Our Team
Our Location
View Clinic
Work at ACM
Services
Appointments
Assessment
Therapy
Therapy
Clinic Therapy
School Therapy
Intensives
Groups
Groups
Early Language Groups
Social Communication Groups
Literacy Skills Groups
School Readiness & High School Success Groups
Group FAQs
Screening
Parent / Educator Talks
Staff Training
Offsite Speech Therapy Services
Groups
Early Language Groups
Social Communication Groups
Literacy Skills Groups
School Readiness & High School Groups
New Clients
Booking Speech Therapy
Book Now
Resources
FAQ
When to Seek Help
Developmental Milestones
Parent Tips & Resources
News
Policies
Attendance & Cancellation Policy
Payment Policy
Privacy Policy
Code of Ethics & Code of Conduct Policy
Funding
Medicare
Private Health Funds
NDIS
Feedback
Client Feedback
Complaints
Book Now
Contact Us
Main Menu
Home
About
Our Team
Our Location
View Clinic
Work at ACM
Services
Appointments
Assessment
Therapy
Therapy
Clinic Therapy
School Therapy
Intensives
Groups
Groups
Early Language Groups
Social Communication Groups
Literacy Skills Groups
School Readiness & High School Success Groups
Group FAQs
Screening
Parent / Educator Talks
Staff Training
Offsite Speech Therapy Services
Groups
Early Language Groups
Social Communication Groups
Literacy Skills Groups
School Readiness & High School Groups
New Clients
Booking Speech Therapy
Book Now
Resources
FAQ
When to Seek Help
Developmental Milestones
Parent Tips & Resources
News
Policies
Attendance & Cancellation Policy
Payment Policy
Privacy Policy
Code of Ethics & Code of Conduct Policy
Funding
Medicare
Private Health Funds
NDIS
Feedback
Client Feedback
Complaints
Book Now
Contact Us
Group Registration
Register your interest via the group form below
Group Registration
Client Name
(Required)
First
Last
This field is hidden when viewing the form
Today
(Required)
Date of Birth
(Required)
This field is hidden when viewing the form
AgeYears
This field is hidden when viewing the form
AgeMonths
Age :
Years,
Months
Parent / Guardian Name
(Required)
First
Last
Contact Email
(Required)
Are you an existing (current or past) client of ACM?
(Required)
Yes
No
Existing Parent / Guardian Phone
(Required)
Parent / Guardian Phone
(Required)
Location
(Required)
Erina
Hornsby
Reason for referral to groups
(Required)
Is the client currently attending individual speech pathology services elsewhere?
(Required)
Yes
No
Name of Service Provider
(Required)
Goals and Additional Information
(Required)
This field is hidden when viewing the form
Required Skills
(Required)
Group Confirmation from client or their representative that group participant meets recommended skills
(Required)
The skills for this group are outlined below:
I confirm that the group participant meets these skills outlined above
I have previously discussed the group participant’s skills with their individual ACM clinician and agreement has been reached for my child to attend group
I am new to ACM and the group participant may have difficulties with some of the recommended skills. I have listed these skills for further discussion (below)
Group Confirmation from parent/guardian that child meets required skills
(Required)
The skills for this group are outlined below:
I confirm that the group participant meets these skills outlined above
I have previously discussed the group participant’s skills with their individual ACM clinician and agreement has been reached for my child to attend group
I am new to ACM and the group participant may have difficulties with some of the recommended skills. I have listed these skills for further discussion (below)
Skills for further discussion
(Required)
Parent confirmation/terms and conditions tick boxes next to statements below.
(Required)
I have reviewed the goals of the group and wish to proceed with registration for this group as listed on the relevant group page of the ACM website
I have reviewed the recommended skills to attend this group and these criteria are met
I understand that ACM staff will review registrations and the information I provide to help determine/ ensure suitability for group before a group booking is confirmed
Terms and conditions of group bookings (
click to view
)
I confirm that the information I have provided is correct and that I wish to proceed with the registration
(Required)
Yes I agree
Price Details
(Required)
This field is hidden when viewing the form
Enrolment Price
(Required)
Are you an NDIS Client?
(Required)
Yes
No
Are you self managed?
(Required)
Yes, we are self managed
No, we are plan/agency managed
Does ACM already have your plan details?
(Required)
Yes
No, we need to provide this to you
NDIS Details
(Required)
Please enter your NDIS details below - NDIS number, plan start and end dates and plan manager name
Consent
(Required)
I confirm that I am registering for an NDIS Plan Managed/Agency Managed client and I authorise for the enrolment fee to be debited. (I understand that it is my responsibility to provide current plan and plan manager details to ACM)
Group Enrolment
(Required)
Price:
Credit Card
(Required)
