Waitlist Form

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Hello, and welcome to Thriving Lotus Therapy! We are excited to meet you and learn how to best support you and your family.

Please complete the form below and we will be in contact with you as soon as a spot becomes available.

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Your full name:* This field is required.

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Email Address: * This field is required.

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Address:* This field is required.

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Phone Number:* This field is required.

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Child's Name: * This field is required.

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Your Child's current age: * This field is required.

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Child's DOB: * This field is required.

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Child's Diagnosis if any:* This field is required.

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Does your child currently/previously seen a Speech Pathologist or Occupational Therapist?* This field is required.

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What are your preferred days/times for sessions?* This field is required.

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Where would you prefer your child's therapy?* This field is required.

Home

School

Kindergarten

Childcare

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Funding Type:* This field is required.

NDIS Self Managed

NDIS Plan Managed

Currently awaiting on funding

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What are your main concerns/areas you would like worked on in OT?* This field is required.

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Other:

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My Child/I Communicate in this way:* This field is required.

Using full sentences

Using single words

Non speaking

Uses a communication device (AAC)

Other

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Other:

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List any other information you feel is important for your Occupational Therapist to know:

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How did you hear about us?* This field is required.

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Thank you for taking time to fill this waiting list form. We will be in contact within the next 7 days.