New Client Inquiry Form

Name of Child *

First Name

Last Name

Name of Parent *

First Name

Last Name

Which services are you interested in accessing?

Speech Pathology

Occupational Therapy

Social Skills and Community Participation Programs

Holiday Programs

Social Worker

What best describes your needs?

Assessment only

Assessment and ongoing therapy

Ongoing individual therapy

Social Skills and Community Participation Programs

In what setting does your child have the most difficulties?

School

Home

Community

Which of the following areas would you like addressed?

Fine motor skills

Gross motor skills

Attention and focus

Speech sounds

Communication skills

Behaviour

Self-care skills

Eating/feeding

NDIS application report

School support letter