First name * Last name * Preferred email * Phone number Best time to contact you and discuss support How would you like to be contacted? SMSPhoneEmail About the child or client Child / client first name Child / client last name Age(s) of identified client(s) Your relationship to client(s) For example: mother, father, step-parent, other family member or significant person, professional, adoptive parent, foster carer. Does the child / client have a current diagnosis, or are they undergoing assessment? (if applicable) How we can help Are you familiar with the Play Therapy modality, or would you like a little more information? What is your motivation for seeking Play Therapy at this time? Is the child currently engaging with additional support services or interventions? This may include OT, speech pathology, paediatrician, psychology or behavioural support. Has the child / client had any previous experience of interventions or therapy? This may include OT, speech pathology, paediatrician, psychology or behavioural support. Availability and anything else What is your availability for sessions? Mon–Fri, 9–12 (AM) and 1–5 (PM) Mon AMMon PMTues AMTues PMWeds AMWeds PMThurs AMThurs PMFri AMFri PM How did you hear about our services at The Play Therapy Studio? Any additional information, or questions you may have, that would help us support you and your family
