About your child

Child’s first name

Child’s last name

Child’s date of birth

Gender

Male Female Other

Child’s preschool / school

Child’s school grade (if applicable)

What days does your child attend preschool / day care? (if applicable)

NDIS number (if applicable)

Primary diagnosis (if applicable)

Siblings (name and age)

Languages spoken at home

If English is not your child’s first language, how long has your child been speaking English?

Primary contact

First name

Last name

Relation to child

Phone number

Email

Street address

Secondary contact (optional)

Another parent or carer we can contact about your child, if there is one.

First name

Last name

Relation to child

Phone number

Email

Your concerns

What are your current concerns?

Please provide details about your concerns

Has your child seen an occupational therapist before? If yes, please provide details

Do you currently receive any other services?

Anything else

Any other information

Additional important health information, notes or comments

Care arrangements or health conditions / allergies that may be important

How did you hear about us?

Additional documentation (optional — an NDIS plan, reports or a GP care plan: PDF, Word or images, up to 5 files of 10 MB each)

Your documents travel with this enquiry and are not kept on the website. Too big, or not working? Email them to hello@littlelegendsot.com.au after you send this form.

Check your answers

Please check everything is right before you send. Use Change to go back to a question.

Contact Us

Thank you — we’ve received your message

Email

Location

New client enquiry

Check your answers

Contact Us

Thank you — we’ve received your message

Email

Location

New client enquiry

Check your answers

Stay in the loop