Initial Enquiry Notice

SEPT/ OCT -2025

DUE TO CURRENT CAPACITY AND STAFFING

VIVA KIDS OT IS CURRENTLY

NOT TAKING ON NEW REFERRALS AT THIS TIME.

THERE ARE SOME OTHER PAEDIATRIC SERVICES ON THE SUNSHINE COAST

THAT MAY BE ABLE TO ASSIST YOU.

THANK YOU FOR YOUR UNDERSTANDING.

Thank you for being in touch - via our Initial Enquiry Form.

Please note the following:

Our appointments and availabilities can vary depending on the time of year , and the current capacity of the service.

The service operates for 48 weeks a year - closed for 2 weeks at Christmas and 2 weeks mid year.

We make every effort to reply to Initial Enquiries to advise of our current capacity within 7-10 working days.

Thank you for your understanding - Best Regards The Viva Kids OT Team :)

General Details

Date of Enquiry *

Parents /Carer's First Name *

Child's First Name *

Age of Child: *

Email Address *

Phone Number *

Town/Suburb: *

Name of DayCare / Kindy / School Attended:

Does your child have a Diagnosis Yes / No *

If Yes - At what age was your child diagnosed? *

What is your child's Diagnosis? *

Funding for Occupational Therapy Services (please select your funding type) *

Reason for Seeking Occupational Therapy Services

Do you have any concerns in any of the following areas? Please indicate Yes or No.

EATING *

YesNo

SLEEPING *

YesNo

TOILETING *

YesNo

GROSS MOTOR CHALLENGES - (eg. running, jumping, ball skills, sports) *

Yes No

FINE MOTOR CHALLENGES - eg. Writing /Scissors/ Shoe Laces/Buttons *

YesNo

LEARNING CHALLENGES (eg. reading, writing, maths, remembering everyday information) *

Yes No

BEHAVIOUR CHALLENGES *

YESNO

What is your main concern regarding your child's behaviours? (eg. Compliance/Attention/ cooperating with others/ Anger/ Meltdowns) *

EMOTIONAL CHALLENGES *

YesNo

What is your main concern regarding your child's social /emotional responses? (eg. Overly Emotional / Under- Emotional and reactive /Difficulty with change of routine/ transitions)

RELATIONSHIP/ FRIENDSHIP / PLAY *

YesNo

Has your child seen an Occupational Therapist before? *

YesNo

If Yes - which Occupational Therapy Service and for how long? *

Which other Allied Services is your child seeing currently? (please list) *

Were you referred by someone to our service? Yes/ No - If Yes please advise.

How did you hear about Viva Kids OT? (Please Select from the listed options) *

Please indicate what Occupational Therapy Services you are looking for. *

Assessment Only Assessment and Therapy Therapy ( my child has a recent OT assessment within 6 months)

If you are looking for ongoing therapy - please indicate the frequency of appointments you are looking for? *

WeeklyFortnightly Not Sure

What are your preferred appointment days / times? *

Are you flexible with these times. *

Yes No

Additional Comments: Please add any other relevant information

PLEASE NOTE THE FOLLOWING:
• Our after school appointments are the most sought after for school-aged children.
• If you are flexible with your times available - there may be a greater opportunity to provide services sooner.

Warmest regards

The Viva Kids OT Team :)