HomeRegister – Go For Goals Therapy Block Register – Go For Goals Therapy Block Therapy Block Customer Name First Last Age of Customer(Required)Contact Name(Required) First Last Contact Phone Number(Required)Contact Email Adress(Required) Discipline(Required)Occupational TherapySpeech TherapyPhysiotherapyGoal(Required)Functional Capacity AssessmentFine Motor Tabletop ActivitiesFunctional Kitchen ActivitiesActivities of Daily LivingTransport AssessmentSchool ReadinessTransitions and Daily RoutinesFeeding (Exclusions Apply)GoalClear SpeechLiteracyNarrative or Story RetellSocial SkillsMealtime ManagementCommunication AidsSchool ReadinessGoalMobility and TransfersToe WalkingStrengthening and StabilityHydrotherapyPlayground ActivitiesEarly Motor DevelopmentHiddenPreferred DayMondayTuesdayWednesdayThursdayFridayHiddenPreferred Timeslot Morning Afternoon Would you be interested in accessing Go for Goals via Telehealth?(Required) Yes No Please note that for customers in the Geraldton region, this service is only available via Telehealth.Have you taken part in the Go for Goals program before?(Required) Yes No Preferred Contact Method(Required)EmailPhone CallSMSHow did you hear about us?(Required) Google Social Media Customer Testimonial Email Referral Other Δ
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