Welcome to Collaborative Partnerships, Paediatric Occupational Therapy.

Please complete this New Client Registration form - all information will be regarded as strictly confidential.

Parent/Carer Details

Your Title *

Your First Name *

Your Last Name *

Your Mobile *

Your Email Address *

Child's Details

Title. *

First Name *

Last Name *

Preferred Name

Date of birth *

Sex *

Gender

Street Address *

Street Address 2

City *

State *

Postcode *

Funding

Funding Type *

NDIS Plan ManagedNDIS Self ManagedPrivate (includes Private Health Insurance)GP Referred Care Plan (Medicare rebate)Other Eg. Organisation or 3rd Party

NDIS Plan Manager email for invoices *

Medicare EPC/CDM Care Plan

Browse

Organisation/3rd Party Billing Details *

NDIS Plan End Date *

Other

Please add any additional information and/or upload any documentation you feel may be relevant.

A representative from our Client Support Team will be in touch very soon to discuss the next steps
in your child's intervention.

Thank you.

Additional Comments/Information

Additional Documentation

Browse