NDIS Referral Form For Kids (<16 Years)This form can be used for our documentation if you are referring an eligible NDIS client to us. Referral - NDIS For Kids Referrer Name (required) * Referrer Email (required) * Referrer Phone (required) * Participant Name (required) * Participant Date Of Birth (required) * Participant Age (required) * Participant Address (required) * School Name (required) * School Year (required) * NDIS Number (required) * Guardian 1 Name (required) * Guardian 1 Email (required) * Guardian 1 Phone (required) * Guardian 2 Name Guardian 2 Email Guardian 2 Phone Medical History/Disability/Diagnosis (required) * Strengths and Interests Reason for seeking occupational therapy (required) * Preferred Appointment Location (required) * Home School Amaroo Clinic Preferred Time (required) * Preferred Day (required) * Have You Noticed Difficulty with Any of the following Activities : * Hand Writing (Letter Formation, Fatigue) Feeding/meal time (Using cutlery, eating independently Toileting (Contience ,using toilet, washing hands) Dressing (Buttons, zips, shoelaces) Shower/ bath time (washing body & hair) Grooming (Hair brushing, cutting nails, brushing teeth) Playing with friends/family (Initiating play, trying new games) Sleeping/bed time (Trouble settling down, restless, waking up) Transitioning from one activity to another (Flexibility in play, fixated/obsessive on task) Emotional regulation (Immoderate emotional response to situation ) Stimming/self regulation (e.g flapping hands, rocking, head banging) Other(Anxiety, attention, etc.) Captcha If you are human, leave this field blank. Submit