Can my child access therapy with OT FOR KIDS?

Child’s name*

Name Family name

Child's date of birth*

Child’s age*

Please enter a number from 0 to 19.

Child’s gender*

Male

Female

Child’s address*

Street address City ZIP / Postal Code

Child's cultural background*

Languages spoken at home*

Child’s confirmed or suspected diagnosis*

What school does your child attend?

Please type N/A if your child is not yet school-age.

School grade/year?

Please type N/A if your child is not yet school-age.

About Me

Name of parent*

First Last

So that we can contact you by name.

Best contact phone number*

Parent’s best email address*

Language other than English

Yes, I need an interpreter

Enquiry Details

Please describe or list what you are hoping to work on in occupational therapy*

Which areas of your child’s development concerns you?*

What are your child’s strengths?*

Which services would be of help to you?*

One-to-one intervention

Home-based consultation

School or preschool/child care visit

Telehealth or online therapy

Group program

Assessment only

Coaching and parent information

Which days or times would fit best with your family’s schedule?*

Do you need an after-school appointment time?

Yes

Do you want to be contacted for an urgent assessment in case of last minute cancellations?

Yes

What funding pathway are you wanting to use for OT?*

Private paying

NDIA managed

Self managed NDIS

Plan managed NDIS

Waiting for NDIS funding

How did you find out about OT FOR KIDS?

Digital (Google or other search, website)

Social media (Facebook)

Word of mouth

Referral from a friend, family or colleague

Referral from Blacktown Speech Pathology Services

Referral from another professional, such as NDIS LAC, paediatrician or your GP

Referral from a school or early childhood centre

Special choice

I would like to be invited to an online OT FOR KIDS ‘Cuppa and Chat’ Session.

These are short, online advice and/or information sessions offered to parents who are waiting for OT services and register via this form.

Comments

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