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Intake Information and Preliminary Assessment Form (for ages 4 to 17)


What is Working Memory Training?

Can we improve Working Memory?

How does Cogmed Working Memory Training work?


For more information visit:


We are currently offering 50% off our full rate, bringing the total cost down to:



Cogmed Training payment options:

- Private

- NDIS Therapeutic Support Funding Item (under Capacity Building)

Please note: Prior to commencing the program, FULL PAYMENT is required. 

Once commenced, the payment is NON-REFUNDABLE (due to the purchase of online user access fees and other pre-preparation).


For this reason, eligibility assessments are conducted online for free prior to acceptance, to ensure training suitability, and that participants have the best chance of effectively completing the full program. The training requires commitment, motivation and hard work (whilst having fun)!


(FOR AGES 4-17)


Please complete the preliminary eligibility form below.

 Once your answers are reviewed, you will be emailed a response which indicates whether you are able to proceed to the next assessment stage.



Please answer the following questions to help to determine the first stage of eligibility.

What is your child's name (who wants to access the training)?*

How old is your child?*

What is your child's gender?

Select an option

What is your name (as parent, carer, etc)?*

Phone Contact Number*

Email Address

Address (or at least the town you reside in):*

If eligible, my child would like to access this training program using:*

Select an option

Where did you hear about Cogmed Working Memory Training?

Do you have good unlimited internet access at your home?*

Select an option

Does your computer have a well functioning mouse?*

Select an option

Can your child manage a computer mouse?*

Select an option

How does your child cope when playing computer or videogames?

Training time could range from about 30 to 60 minutes, 3 to 5 days per week (depending on the chosen intervention). Up to an hour may be required to accommodate the training and any breaks. Can you set aside an hour per training day (could be 3 to 5 times a week, for up to 5 to 14 weeks)?*

Select an option

Children need someone to sit next to and support them during training (if not attending our clinic). Who will be the appropriate training aide for your child?

The training environment needs to be a quiet, private room with a computer. Do you have the possibility to create a good training environment?*

Select an option

I am hoping that my child can complete the training...*

Select an option

Please submit your responses by clicking on the 'submit' button below. Thank you for your responses, we will send you an email within a few days to indicate the next step!

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