Please complete this form to request the Tomatis® Evaluation Database (TED®) questionnaires. The questionnaires take about 10-15 minutes each to complete. The purpose of these questionnaires is to confirm suitability for starting a listening programme.

Please be reassured that the information is strictly confidential and not shared with Tomatis® Developpment S.A. If any of the questions or scoring do not seem relevant then please mark as '0 - not applicable'. The aim is for me to capture as much information as possible because every detail helps.

Sound learning for life.

Child Name

Please enter child's full name.

First Name

Last Name

Date of birth:

This is required to activate an age appropriate questionnaire.

MM

DD

YYYY

Email

Please include your preferred email contact address.

Contact name:

Please give contact name of adult and relationship to child.

Where are you located?

I am often able to offer a home visit depending on location.

Background Information

Please include a few lines to describe the reasons for wanting to start Tomatis® sound and listening therapy.

Email:

cat@thesoundteacher.co.uk

Please complete this form to request the Tomatis® Evaluation Database (TED®) questionnaires. The questionnaires take about 10-15 minutes each to complete. The purpose of these questionnaires is to confirm suitability for starting a listening programme.

Sound learning for life.

Cat Robbins