Occupational Therapist e-Form Existing Patients

Occupational Therapist e-Form Existing Patients

Dear parents effective from 01/02/23 OT fees are payable on the day of the consultaion by cash or EFTPOS for appts in the clinic. For outside the clinic appts (home or school visits) fees are payable on the day of the consultation or any other day by authorising the clinic to debit your credit or debit card shared as per our updated policies and procedures (please see below).

(Please fill out all the fields) (Form: occuth2review)

Child's (Patient) Details

Date of Birth

Parent Details


PRIVACY INFORMATION AND CONSENT

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Yes, I agree to the privacy and parent consent information above.

Payment Details

Credit Card Type
Card Number: