Referral

Ready to get started? Feel free to fill out our referral form to begin your OT journey with us. Whether you're a parent, teacher, or healthcare professional, we look forward to supporting your child’s development every step of the way.

Fill out the Referral Form on the right or simply contact us for a referral — we’re excited to support you and your child on their OT journey!

Engage and Achieve OT Client Intake Form

Child's Name and Date of Birth*

Referrer's Name*

What is your relationship to the child or your professional role?

Contact Details*

Please provide your email and/or phone number.

Address*

Has your child received any formal diagnoses *

Yes

Please list any relevant diagnoses (e.g., Autism, ADHD, Global Developmental Delay)

What functional challenges is your child currently experiencing?

Self-care (e.g., dressing, toileting)

Fine motor skills

Gross motor skills

Sensory processing

Attention and focus

Social skills

Emotional regulation

Other

Please provide a brief description of the concerns

Funding Type

NDIS – Self Managed/ Plan Managed

Private (out-of-pocket)

Medicare

Other

Privacy & Consent

By submitting this referral, I confirm that I have obtained parental/guardian consent to proceed and acknowledge that all referrals are handled with strict confidentiality.

Engage and Achieve OT

Phone: 0431 6399 53

Email: abby@engageandachieveot.com.au

Upper and Lower North Shore, Hill District

Monday - Friday 7:30am - 4:30pm

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