Contact Form

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*
Parent/Caregiver Details*

First NameLast Name
Email*
example@example.com
Contact number*
Child's date of birth*

DayMonthYear
Date
Please note: we currently only take children under 13 years for assessment. If your child is over 13 years of age we will be unable to provide therapy.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
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?*

MondayTuesdayWednesdayThursdayFriday
What time are you able to attend therapy on these days?*

MorningMiddayAfter school (Currently not Available)
Would you be interested in Telehealth services?*

YesNo
Services needed: (Please click all that apply)

OT Comprehensive Evaluation/ReportOccupational TherapySecret Agent SocietySense RugbyFunctional Capacity Assessment for NDISPsychology
Services needed: (Please click all that apply)

Occupational Therapy Comprehensive Evaluation & ReportOccupational TherapyPsychology Intervention for parentsFamily Psychology InterventionPsychology Intervention for child/teen (over the age of 8)Functional Capacity AssessmentSense RugbySecret Agent Society
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 fundingSelf managed NDISPlan managed NDISNDIA managed (funding is held by NDIS)Awaiting NDIS funding
How did you hear about us?*

Web searchSocial Media - Instagram/Facebook/TiktokWord of mouth / friend recommendationReferred by NDIS coordinatorSchool referralReferred by Health ProfessionalOther
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 asapNo we can only make after school
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Contact form