Maryborough Psychology & Health Clinic Melinda Metaxas & Associates Pty Ltd Toggle NavigationHomeServicesReferrals & FundingFeedbackOur VisionAboutContactHomeServicesReferrals & FundingFeedbackOur VisionAboutContact Parent Form Section F - Family Please list everyone that your child lives with. Include ages of any siblings:Is there a history of learning difficulties in the family?NoIntellectual DisabilityDyslexiaTrouble reading/writingSpeech or language difficultiesAttendance at a special schoolLeft school earlyOtherPlease explain any other:Are you aware of any family or other issues that may be contributing to your child's academic difficulties?BehaviourAttentionSocial-emotionalTraumaPoor school attendanceParental separationCustodial issuesOther diagnosisIf so, please explain:Is there any other information about your child that you would like to provide?This site uses Google reCAPTCHA technology to fight spam. Your use of reCAPTCHA is subject to Google's Privacy Policy and Terms of Service.Submit DetailsThere are no more questions! Thank you for completing the Parent/Carer questionnaire! / PreviousNextPausePlayClose