Relationship focused Occupational Therapy for families with children 0 to 12 years.
Child's Name
*
Enter the child’s full name
Child's Date of Birth
*
Day
*
Month
*
Year
*
Enter the child’s date of birth
Parent or Caregiver's Name
*
Enter the parent or caregiver’s full name
Phone Number
Enter a phone number we can reach you on
Email Address
*
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What brings you to Aware Space?
Share a short description of why you are seeking occupational therapy support
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What type of support are you looking for?
*
Assessment + Recommendations Report only — please note this does not guarantee availability for ongoing therapy
Assessment + Ongoing Therapy (if recommended following assessment)
Ongoing Therapy only — I have a completed assessment from within the last 12 months
Select the option that best describes the support you are hoping to access
Preferred Time of Day
*
Before school
During school hours
After school
Select all times that work for your family
Preferred Days
Monday
Tuesday
Wednesday
Thursday
Friday
Select all days that work for your family
Anything else you'd like us to know?
Optional space to share anything else relevant to your enquiry
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