Intake & consent form for Career assessments

Medical aid details

Please note that Dayne Williams operates a cash practice and therefore you are responsible for payment. Once payment has been made you will be issued with a receipt which can be used to claim back from medical aid. Please consult your medical aid first to provisions are made for career assessments.

Parental details

Details of child:

Click or drag a file to this area to upload.

Consent form

Please sign below is you consent to the following:
1. Give permission that my/our child/the person under my care), meet with Dayne Williams (Educational Psychologist) for a career assessment.
2. Acknowledge that all private information collected about you and/ your child will be treated as highly confidential; no information will be disclosed without your consent, unless required to do so by the Court of Law.
3. Acknowledge that I/we gave my/our consent, willingly and without being unduly influenced to do so by any person.
4. Give consent to communicate information and reports (where applicable) via email and/or Whatsapp messaging platform.
Please use mouse (pc) or finger (phone/tablet) to sign
Please use mouse (pc) or finger (phone/tablet) to sign