Occupational Therapy PRE-Consultation Questionnaire

Please fill out the following form & send it to us using the Submit button at the bottom.

Name Date of birth

Parents Names Address

Contact Number (Home | Mobile)

School/Preschool & year level

Background history, including significant medical events

Educational History

Social/personal situation

Previous assessments

Strengths and Weaknesses

Personal care skills eg. dressing, eating & grooming

Family's concerns

Any other information you feel would help in your child’s assessment

Thank you for taking the time to fill this out. I look forward to meeting with your child.

Occupational Therapy Team