WELCOME TO THE SOULUTIONS CENTRE

We offer three tailored pathways to help you understand yourself more fully and access the right support. This short form will help us guide you toward the most suitable option. Please note: This is an intake screening form, not a diagnostic tool.

Phone *

Full Name *

Preferred Name

Date Of Birth *

Email *

FOCUS OF ASSESSMENT

Which areas are you most curious about? *

ADHD

Autism Spectrum

Both ADHD & Autism

Unsure (please guide me)

What brings you to seek an assessment at this time? *

For example: challenges with focus, memory, sensory experiences, burnout, relationships, study/work performance, or wanting a clearer sense of identity.

Please list any health professionals you’re currently working with

Are you currently working with any health professionals (e.g. GP, psychologist, psychiatrist, allied health)? *

Yes (Please Describe)

Have you previously had any form of neurodiversity assessment? *

Yes (please describe)

Please describe the type of assessment and when it occurred.

Which assessment pathway best fits your needs? *

I want a clear screening overview and basic guidance (Lite Assessment)

I want a full diagnostic process with psychometric testing, developmental history, and detailed report (Comprehensive Assessment)

I’m not sure which assessment type is best for me (Pathways Discussion)

This helps us guide you toward the most supportive option for your goals.

Please describe any other areas impacting you

Which areas are currently impacting your daily life? (Tick all that apply) *

Attention/focus difficulties

Organisation, planning, time management

Sensory sensitivities (e.g. noise, light, clothing textures)

Masking or “camouflaging” in social situations

Burnout or exhaustion after social/work demands

Relationship challenges (feeling misunderstood, difficulty sustaining connections)

Academic or workplace performance concerns

Emotional regulation difficulties

Other

Preferred mode of assessment *

In-person (Melbourne)

Telehealth (Australia-wide)

How soon are you hoping to begin? *

As soon as possible

Within 1–3 months

Flexible

I understand that this form is for intake and triage purposes only, and does not constitute a formal diagnosis. I consent to The Soulutions Centre contacting me about booking an assessment. *

I understand