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Home
About
Our Team
Our Purpose
Careers
Media
Policies
Therapy
Occupational Therapy
Speech Pathology
Physiotherapy
Psychology
Dietetics & Nutrition
Block Therapy
Telehealth
Programs
Members
Timetable
Store
Contact
Where Therapy Meets Play
Enrol
Therapy Enquiry
Term Program Enquiry
Holiday Programs Enrolment
Participation Agreement
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
Email
*
Phone Number
*
Member (Child) DOB (DDMMYYYY)
*
School/Childcare 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
If Home or School visits are preferred, what is the suburb?
*
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
No assessments required
Diagnosis, condition or injury details.
*
Therapy/ treatment goals
*
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
Thank you!