Join our Waitlist - Motivate Kids

ABOUT YOU

Parent / Carer name(Required)

First Last

Parent / Carer Mobile(Required)

Parent / Carer Email(Required)

Date of Completion

DD slash MM slash YYYY

ABOUT YOUR CHILD

Child name

First Last

Child date of birth

What is the main reason you are seeking OT for your child?

The focus areas I would like my child to improve include:

Does your child have a diagnosis?

Yes

What is the diagnosis?

Has your child had OT in the past?

Yes

How long ago did your child receive OT?

0-3 months

3-6 months

6-12 months

Over 12 months ago

Do you have a recent OT Assessment Report?

If this is valid you may be able to start sessions without an Initial Assessment. This does not include the NDIS Review reports or diagnostic assessments.

Yes

FUNDING

How will your OT be funded?

NDIS Self Managed

NDIS Plan Managed

Private

Care Plan

DCP

Other

PREFERENCES

The Motivate Kid journey is comprised on multiple steps.

Step One: Initial Assessment (at Prospect or Salisbury Studio)
Step two: Parent-Carer Feedback Meeting (Prospect or Salisbury Studio)
Step Three: weekly or fortnightly sessions – this can be at your preferred location, day and time.

We thank you for your flexibility to attend either our Prospect or Salisbury site for step one and two. Please see our Motivate Kids Journey Flyer for all our steps so we can tailor the OT journey to you and your child

Which location is preferred for therapy sessions?

Please select multiple if more than one is suitable

Prospect Studio (Broadview August 2023)

Salisbury Studio

Blakeview Studio

Northfield Primary School (enrolled students only)

Tyndale Christian School (enrolled students only)

How often do you prefer therapy sessions?

Weekly

Fortnightly

What day will be suitable for therapy sessions?

Please select multiple if more than one is suitable

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday (Salisbury and Blakeview only 8-3pm)

What time will be suitable for sessions?

Please select multiple if more than one is suitable. Please note sessions start on the hour and run for 50 minutes.

8am

9am

10am

11am

12pm

1pm

2pm

3pm

4pm

5pm

Motivate Kids offer one off ‘Regulation Sessions’ which are an opportunity for you to bring your child in for some therapy sessions while you wait for your initial assessment.
This gives your child the opportunity to work on regulation and skill development as well as for you to receive strategies from the OT to get you started.

Any further specific information you would like Motivate Kids to know

Are you flexible to attend a last minute cancellation for your child to have their initial assessment earlier?

Yes

Are you interested in booking in a regulation session?

You can book one or multiple. Please note that the time, day, location and therapist may change each session based on your preference and availability

Yes

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