CONTACT US

Join Our Waitlist

By completing this form your child will be placed on our waitlist. All sections are required to be completed. There is currently an extensive waitlist and wait time may exceed 12 months for some services.

Contact Information

First and Last Name of the Person completing the form

Relationship to child, e.g., parent, support coordinator.

Child's First and Last Name

Child's Date of Birth

Month

Day

Year

Child's Gender

Female

Male

Other

First and Last Name of the Person to contact regarding appointments, if different to above.

Phone

Concerns:

What concerns do you have about the child's communication?

What concerns do you have about movement?

No concerns about movement

Small movements such as drawing, handwriting and doing up buttons

Large movements such as walking, crawling and balance

Other

What concerns do you have about academic skills?

What concerns do you have about eating and drinking?

No concerns about eating and drinking

Concerns about choking on food and swallowing

My child is a picky eater and has a very limited diet

Difficulties using cutlery and self-feeding

Other

What additional concerns do you have?

I have no other concerns

Differences with the processing of sensory information such as loud noises, the feeling of clothing tags or sensing body signals

Difficulties with self-care and following routines

Transitioning into, and preparing for Prep

Life transitions such as a new sibling, family breakdowns, beginning high school, moving house, starting a job etc

Other

Additional Information

Does the child have a current NDIS plan?

Has the child had a hearing test?

Is English the main language spoken at home?

Apart from English, what languages are spoken at home?

Appointments

As we have an extensive waitlist, we like to offer one-off appointments to those who may be interested, when possible. Please indicate when you would like to be contacted.

I only require an assessment - no ongoing therapy

I only want to be contacted when there is a place available for regular therapy

I would like to be contacted at short-notice for a one-off appointment at any day or time, which is only available because a current client has cancelled their booking for that day. I understand that ongoing therapy appointments will not be offered at that time, but that I will remain on the waitlist for follow-up.

I would like to be contacted for school holiday appointments, which are available because a regular client has cancelled their bookings for the holiday period. In this case there may be several appointments available, all during the holidays. I understand that appointments will not be ongoing once school resumes but that I will remain on the waitlist for follow-up.

I am interested in the Curious Crocodiles developmental program for children entering Prep next year.

I am interested in the Busy Bandicoots developmental program for children of approximately 3 years of age.

I am interested in a small group Sounds-Write literacy program

I am interested in the SOS Approach to Feeding