Active Eight Therapy Enquiry Form

Which best describes you? *

New to Active Eight!

Already a Member!

Members (Child) Name *

First Name

Last Name

Parent / carer Name *

First Name

Last Name

Which therapy would you like to enquire about? *

Occupational Therapy

Speech Therapy

Psychology

Physiotherapy

Dietetics

Location preference (you can select multiple locations) *

Active Eight Hub (67 High Street, Toowong)

Home visits

School/ Childcare

Online/Telehealth

Are you interested in appointments during the school holidays through a block therapy model? (intensive approach) *

Yes

No

Holidays are preferred

Do you require any of the following assessments? *

Cognitive (Psychology)

Functional Capacity (Occupational Therapy)

Sensory (Occupational Therapy)

Speech and Language

Movement (Physiotherapy)

Nutritional (Dietetics)

Unsure

OT & SLP Screener (Childcare Offering ONLY)

Dietetics Screener (Childcare Offering ONLY)

Physio Screener (Childcare Offering ONLY)

No assessments required

Do any of the following apply to your circumstance? If YES to ANY of the below please send plans/details in an email to admin@activeeight.com.au after submitting this form.

Positive Behaviour Support Plan

Custody, Parenting or guardianship orders

Medical Response Plans (Seizure management, asthma, allergies etc.)

Parent/ carer requires a translator

How did you hear about us? *

Word of mouth

Google

Health Referral (GP, health professional )

School

Instagram or Facebook

Source Kids/ Other Expo