Group Registration

5 Week Group

Sensory Explorers (2-5yrs) - Wednesdays from 12th March to 9th April (10am - 11.30am)

You understand and agree to the following terms:

I understand this is an expression of interest and services will be based on capacity and numbers for groups. Submission of this form does not guarantee access to services.
I am aware that acceptance to Groups does not mean that my child will receive ongoing therapy services.
I am aware that groups are run over a set number of sessions and agree to commit to the full program.

I Agree

Please agree to the terms to continue

All groups include;

Initial 15 minute parent phone consultation
Weekly 1.5hr face to face sessions facilitated by qualified Occupational Therapists
End of group summary letter

Cost per group:

Child's Name

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Date of Birth

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Diagnosis / Medical Conditions

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What would you like to get out of the group?

Is there anything that you would like our therapists to know?

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What are your childs interests and/or favourite things?

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Parent/Carer Name

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Mobile

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Address

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Funding source

NDIS Plan Managed
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Paying Privately

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NDIS Plan Dates

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NDIS Number

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Port Macquarie Clinic
14 Siren Road, Port Macquarie NSW 2444

02 6583 4063

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