On-line order


 
Items marked * are compulsory


First name *
Surname(s), Family name(s) *
Date of birth *
Street, number *
Town *
ZIP *

Name and address of the school the child/pupil/student attends (kindergarten, primary school, secondary school. In the case of assessment of school readiness, please also indicate the primary school where the child will be enrolled *

If you (or your child) do not speak Czech, please indicate the language of communication and whether you are able to arrange for an interpreter: *

Class *

Full name of legal representative of the minor *

E-mail of legal representative of the minor/adult pupil *

Telephone number of legal representative of the minor *

Reason for the request – describe briefly the reason for the request *

Do you speak Czech? *



Does your children speak Czech? *



I agree to fill in the questionnaire and to any consultation with the school *



Have you had any psychological or special education counselling/therapy/examination in last 1-2 years or have you received counselling care elsewhere than at PPP Brno? *





If you have final reports (statements…?) from individual examination – from PPP, SPC, or from other relevant examination (eg. Neurology, psychiatry, speach therapy, etc) in electronic form (scan, photo), you can attach the file here:

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Contact us or order online.

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