Appointment Enquiry Form

Thank you for your Enquiry  

Once this form has been submitted you will receive a confirmation email from us immediately

(Please check Email Box including Junk Email)

In Sync Kids Occupational Therapy needs to collect information about you for the primary purpose of providing a quality service to you. In order to commence this process, we need to collect some personal information from you in this form and may also be by phone. This information will be kept private and confidential.

PERSONAL DETAILS

A $100 payment will be requested at the time of the booking the Initial Assessment. 

The payment is part of the full Initial Assessment costs and is non- refundable after booking has been processed. Costs of the Initial Assessment booking will be discussed with you at the time of the phone call and prior to taking payment of the $100. 

This amount covers our clinician's either reviewing and triaging the completed referral form, Initial Parent Questionnaire and/or documentation from any other providers prior to the Assessment taking place.  

REASON FOR REFERRAL

Name of family member and OT