Important

Important This form is used to help our team understand your concerns and prioritise your enquiry. It is not a swallowing assessment and cannot diagnose dysphagia or determine whether swallowing is safe. Completing this form does not replace medical assessment or emergency care. If you are experiencing an immediate medical emergency, significant choking, difficulty breathing, inability to swallow or manage saliva, or another urgent medical concern, please seek urgent medical assistance rather than waiting for a Speechcare appointment.

Disclaimer

The information you provide helps the Speechcare team understand your concerns and determine the most appropriate next steps. It is an initial intake and triage tool only and is not a clinical assessment, diagnosis or assessment of swallowing safety.

Swallowing difficulties can have a range of causes and, depending on the information provided, may require assessment by a speech pathologist, GP or other medical or allied health professional.

The information submitted through this form will be reviewed by the Speechcare team. The priority assigned to your enquiry does not guarantee a particular appointment timeframe or clinical outcome.

If you or your child is experiencing significant choking, difficulty breathing, inability to swallow saliva, a sudden or severe change in swallowing, or another medical emergency, please seek urgent medical assistance rather than waiting for a Speechcare appointment.

By submitting this form, you acknowledge that the information provided is intended to assist with initial triage and does not constitute a clinical assessment or diagnosis.