Book your initial assessment

Complete our background information form so we can determine how to best support you and we will be in touch shortly!

Consent note: By completing this form you are consenting to EC OT contacting you via your preferred communication method. Your information will be kept private, confidential and only used as needed to support your family.

Initial Assessment Form

Name of person receiving services:

First Name

Last Name

Phone

(###)

###

####

Preferred method of communication

Telephone Call

Text

Are you involved with a local Children's Treatment Centre for OT services?

What services are your interested in?

1:1 Nature Based

Group Nature Based

1:1 Occupational Therapy

Parent Consultation

Other

How did you hear about us?

Please provide additional information about your OT goals