Contact Us - Harrisdale Mobile OT

Enquiry

If you have any questions or would like more information, please reach out through our Contact Form or email us directly. We’re here to help!

Full Name

Relationship to client/child:

Contact Number

Email Address

Address

Child's full name

Date of birth

Address

Gender

Ethnicity/Cultural background

What language does your child prefer to speak at home?

Does your child have siblings? If yes, please provide name and age.

Are there any concerns with (please tick all that apply):

General practitioner name and phone number:

Other (please provide details)

Do you give us consent to contact your child's GP and health practitioners?

National Disability Insurance Scheme (NDIS) Medicare Private Health Insurance Plan Private Paying

The child is attending (Please tick all that apply):

Name of school/centre:

What days of the week is your child at school/daycare

Year level

Teacher's name

Teacher's Email

Do you give us consent to contact your child's teacher?

Does your child have any medical conditions (including allergies)?

Please list medication your child is currently on:

Other (please specify)

The client needs assistance with (please tick all that apply):

Other (please specify)

Would you like a pre-consult call to discuss matters that are not beneficial to discuss in front of your child?

Do you require a report from your occupational therapist? (Extra charge will apply)

What kind of appointments are you seeking? (Travel charge will apply)

We would greatly appreciate any feedback from you regarding our service or therapists so we can continue to grow and improve our service delivery!