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Register a child

We invite you to register for our services on behalf of your child or a child for whom you are guardian.

Client details - the child you are registering

Client first name *
Client phone number (if applicable)
Client last name *
Client email (if applicable)
Client address *
Client date of birth *
Client postcode *
Client gender
Client suburb *
Does the client identify as Aboriginal or Torres Strait Islander?
Primary diagnosis
If the client already has a primary diagnosis, please describe it here.

Guardian details

Guardian first name *
Guardian phone number (required if different from client)
Guardian last name *
Guardian email (required if different from client)
Guardian address (required if different from client)
Guardian gender
Guardian postcode (required if different from client)
Do you identify as Aboriginal or Torres Strait Islander?
Guardian suburb (required if different from client)
Language spoken by guardian
If you already have a primary diagnosis, please describe it here.
Interpreter needed?
Does the guardian need an interpreter present

Funding

Funding sources (check all that apply)

Services you are seeking

Service
Outline the services you require
Current concerns
Tell us about your current concerns or needs
Frequency
Prior to our assessment, what frequency of treatment are you contemplating, eg, weekly, fortnightly, etc)
Location