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Contact Request Form

Please complete the short form below to tell us a little about your situation and how we can help. This allows us to understand your needs and guide you towards the most appropriate support. We aim to respond to all enquiries within 1 business day.

About You

Preferred Contact Method - How would you like us to contact you when we receive this enquiry?
By Telephone
By Text Message
By WhatsApp
By Email
When is the best time to contact you?

We need this to plan (and accurately quote for) the logistics of your services

Who Is The Assessment For?

Date of Birth
Day
Month
Year

Please select the learner's age at the time of enquiry. If unsure, choose "Other".

Learners Age
School Year or Educational Stage
Educational Setting

Knowing the educational setting helps us to tailor our support and reporting appropriately.

How Did You Find Us (or who referred you to us)

Tell us how you found out about Dyslexia Southeast
Internet Search Engine
Social Media (Facebook, Instagram etc)
Recommendation from a Friend
Clinical Referral (e.g Doctor, Social worker etc)
Referral from a school

Please tell us the name of the friend, colleague, contact or service who recommended us. This helps us to say thank you and lets us know how you found us. If they shared a referral code with you, enter it below.

Which of our services are you enquiring about today?

I'd like further information about:

6 New Park Avenue
Bexhill on Sea

TN40 1QR

07588 839449

enquiries@dyslexiasoutheast.co.uk

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Our Contact Details

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