Getting to know your child.

Every child has their own way of exploring the world. Tell us about yours so we can plan a thoughtful first visit together.

Occupational therapy intake
Allow about 10–15 minutes. You can leave optional questions blank and discuss them at your visit.

1Your family
2Health & history
3Everyday life
4Review & send

Step 1 of 4Your family

Fields marked * are required. A parent or legal guardian should complete this form.

Child’s full name *Name your child likes to use (optional)Date of birth *Your full name *Your relationship to the child *Email address *Phone number *Contact preference *Languages / interpreter needs (optional)Appointment reference, if you have one (optional)What would you like support with? *What does your child enjoy or do well? (optional)What would you like everyday life to look like? *

Your answers stay in this tab until you send them. There is no saved draft; closing or refreshing the page clears them.