Contact form
Dear Parent, at Kool KATTS we will endeavor to have your child booked in with us as soon as we possibly can. Please complete the below form so that we can contact you with the next steps.
Child's Name
*
Child's Date of Birth
*
-
Day
-
Month
Year
Date
Parent/Caregiver Details
*
First Name
Last Name
Email
*
example@example.com
Contact number
*
Please let us know your child's age
*
Your Suburb
*
What are your main concerns for your child?
*
Is your child speaking/non speaking?
Describe any diagnosis or medical conditions your child has?
*
Are they taking any medications?
What days are you available?
*
Any day
Monday
Tuesday
Wednesday
Thursday
Friday
What time are you able to attend therapy on these days?
Any time
Morning
Midday
After school (Currently not Available)
Would you be interested in Telehealth services?
Yes
No
Services needed: (Please click all that apply)
OT Comprehensive Evaluation/Report
Occupational Therapy
Secret Agent Society
Sense Rugby
Functional Capacity Assessment for NDIS
Psychology
Services needed: (Please click all that apply)
Occupational Therapy Comprehensive Evaluation & Report
Occupational Therapy Sessions
Psychology Intervention for parents
Family Psychology Intervention
Psychology Intervention for child/teen (over the age of 8)
Functional Capacity Assessment
Speech Therapy Assessment
Speech Therapy Sessions
Sense Rugby
Secret Agent Society
Other Group option
School grade/year?
*
What school does your child attend? Are they in a mainstream or support class?
*
Does your child have NDIS funding?
*
Private paying/No NDIS funding
Self managed NDIS
Plan managed NDIS
NDIA managed (funding is held by NDIS)
Awaiting NDIS funding
How did you hear about us?
*
Web search
Social Media - Instagram/Facebook/Tiktok
Word of mouth / friend recommendation
Referred by NDIS coordinator
School referral
Referred by Health Professional
Other
If you were referred by a Health Professional, please provide their name and/or clinic/practice e.g. Dr Lin Paediatrician
Our after school appointments are generally offered first to current clients. If your child is at school would you be interested in an appointment time during school hours and offered an after school time asap.
Yes, we need therapy asap
No we can only make after school
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