NOT IN USE please use 2022 form - do not delete PlayAbility Early Intervention Referral Form  Logo
  • PlayAbility Early Intervention Referral Form

    Please complete as much detail as you feel comfortable providing. We will call you to follow up your referral using the contact details you provide. We are located in the Bega Valley, Far South Coast of NSW, Australia. We can take referrals from Bega Valley Shire LGA and neighbouring LGA's. Please call our office if you live outside these areas.
  • Child and Family Details

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  • Referrer details (if you are the child's parent or carer you can simply write "Parent" or "Carer" in the first box)

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  • Parents/carers should read the following:

    I/we give permission for my/our child to be assessed by the PlayAbility Early Intervention team and for them to:
          1. Retain relevant information for professional use.
          2. Exchange relevant information regarding the child between PlayAbility                and the referringagency/organisation if applicable.

    I understand that I may withdraw this permission at any time.

     

  • WE RESPECT YOUR RIGHT TO COFIDENTIALITY.


    There is a copy of our Confidentially and Privacy Policy on our website (www.playability.com.au) and you can receive a copy on request. Please contact us if you would like a copy emailed or posted to you.

     

    Once you have completed this form please select the 'submit' button below. Our Early Intervention Manager will be in contact with you as soon as possible.

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