Connecting Together Occupational Therapy Registration Form
Please complete this so that we can contact you and make a booking
Please complete all sections, this supports us to communicate with you and to find mileage for community travel to you
Street Address Line 2
State / Province
Postal / Zip Code
What school/daycare does your child currently attend?
What made you contact us for Occupational Therapy services?
Gross Motor and/or Fine Motor skills
Please review the service agreement and the COVID screening form attached, you will be asked to sign the service agreement in your first session, but here you can pre-read it to ensure you agree to the terms of service
Connecting Together service agreement
COVID Appointment Screening Form
I have read the service agreement
I have read and completed the COVID appointment screening form
I will sign the service agreement in our first session..
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