Letters of Justification Form

Letters of Justification Form
Client Name

First NameLast Name
Guardian Name

First NameLast Name
Guardian Email*
example@example.com
Client Day of Birth

MonthDayYear
Who is the therapist?

First NameLast Name
Therapist email*
example@example.com
Which Funding Source*

Jorden PrincipleCKNW Kid's FundVariety Funding
Do we have a positive ASD diagnose?*

YesWaiting for assessmentNo
Complete the sentence
We would like to offer the client with*
(please include the unit) 10 sessions, 20 hours, etc
of*
occupational therapy, counselling sessions, etc.
with*
therapist full name
one of Cherish's*
occupational therapists, registered counsellors, etc
Therapy Plan and Reasoning*
The client presents with challenges that significantly impact their daily living, participation, and quality of life. This service aims to address sensory processing, emotional regulation, and social communication. It would also seek to improve many areas of the client's skills, awareness, and functioning. Timely intervention is necessary to optimize their developmental potential and support their ability to thrive in home, school, and community environments.
Try to keep it to a paragraph.
Quote Table*
Total Amount*
DO put dollar sign if you are inputing a specific amount.

Complete the sentence