Contact CAA - Centre qap

Phone : +41 22 930 88 88

Mon – Fri 8h30 – 17h30

Where can you find us?

Augmentative and Alternative Communication (AAC) – Centre qap – Lokhos Association

8 Rue Jacques-Grosselin, 1227 Carouge

Trams 15 and 17, Industrielle stop 
Trams 12 and 18, Place d’Armes stop 
Bus 21, Place d’Armes stop 
Bus 11, Rue des Mouettes stop

Contact Form

All requests for CAA coverage must be submitted via the contact form.

Please allow 30 to 40 minutes to fill out this form. To complete it, you will need the insurance card for the child in question, as well as the contact information for the people in the network.

PLEASE NOTE: This form must be completed in one sitting. You cannot save it to complete later!

"*" indicates required fields

Step 1 of 8

12%

Company

This field is for validation purposes and should be left unchanged.

Child's first name*

Child's last name*

Patient's date of birth*

DD slash MM slash YYYY

Nationality*

AVS number*

Spoken language(s)*

Legal representative*

Address*

Phone Number*

E-mail*

Is the child receiving Disability Insurance benefits?*

Yes

Health insurance

Name*

Address*

Insured number*

Medical diagnosis

Medical diagnosis (if known)*

Pediatrician's name*

Neuropediatrician's name*

Impairments

Cognitive*

Yes

Remarks*

Visual*

Oui

Non

Visual level*

Blind

Visually impaired with visual acuity

in the right eye*

in the left eye*

Hearing*

Yes

Side of the impairment*

Right

Left

Bilateral

Language / communication*

Yes

Motor*

Yes

Regarding the*

Lower limbs

Upper limbs

Bilateral

Other (describe)

Equipment / Assistive devices in place

Description (wheelchair, walker, etc.)*

Professionals involved in the child's care network

Institution hosting your child

Name and municipality of the institution*

Type of environment*

Specialized environment

Regular environment

Name of the reference person within the institution and contact info (email or phone)*

Is there a Standardized Assessment Procedure (SAP)?*

Oui

Non

Name of the coordinator*

Current therapeutic and medical follow-up in place

Description*

Please list here the current follow-up treatments for the child, along with the name of the therapist(s)/reference person and contact details (email or phone). Ex: SEI, Mr. Dupont, …….@……..com / Speech therapist, Ms. Lalogo, 0XXXXXXXXX / etc.

Current communication situation

Description*

Please describe the communication difficulties experienced by and with the child

The child's current spontaneous means of communication

This refers to the methods used by the child without any technical assistance (such as a pictogram binder). We will cover these assistive devices in a future question.

Au quotidien, l’enfant peut-il réaliser les activités suivantes ?

Has a "yes/no" code (verbal or gestural)*

Yes

Partially

With assistance

Communicates orally*

Yes

Partially

With assistance

Communicates in writing*

Yes

Partially

With assistance

Can read*

Yes

Partially

With assistance

Knows how to use a phone / tablet*

Yes

Partially

With assistance

Knows how to manage the environment (turning on lights, opening doors, etc.)*

Yes

Partially

With assistance

Please describe the yes/no code used by the child*

Is the child capable of pointing to what they want?*

Is the child able to express themselves / indicate a refusal or appreciation through sounds and/or facial expressions?*

Is the child able to communicate a few words orally? If yes, please briefly describe the vocabulary they use.*

Experience with specific communication tools

Does the child use a communication binder?*

Yes

Does the child use pictograms?*

Yes

Does the child use communication gestures?*

Yes

Does the child use any other tool (please specify)?*

Has the child benefited from communication tools in the past that have since been abandoned? If so, which ones, and who had set up the communication system?*

Your expectations

What would the communication aid allow you to do that you cannot currently do in the present situation? What do you believe our expertise can bring to you?*

Finally, how did you hear about us (website, doctor, etc.)?*

Authorization to contact and signature

By submitting this form, I authorize an AAC specialist from the Qap Center to contact the various professionals in my child’s network whom I have mentioned, in order to clarify the nature of the request and verify the relevance of an AAC intervention. Finally, I am informed that the AAC service at the Qap Center is unique in French-speaking Switzerland and that, due to a high volume of requests, processing times may vary. We thank you for all the information provided and will get back to you as soon as possible.

Health insurance

Medical diagnosis

Impairments

Equipment / Assistive devices in place

Professionals involved in the child's care network

Institution hosting your child

Current therapeutic and medical follow-up in place

Current communication situation

The child's current spontaneous means of communication

Au quotidien, l’enfant peut-il réaliser les activités suivantes ?

Experience with specific communication tools

Your expectations

Authorization to contact and signature

Contacts

Opening Hours

Make a donation

Add a new location

Edit Location

Thank you!