Name *

Client's name

First Name

Last Name

With respect for your cultural background, do you identify as having:

Aboriginal origin

Torres Strait Islander origin

Both Aboriginal and Torres Strait Islander origin

Neither

Welcome Pack Questionnaire *

To download these forms, click on the links at the top of this page, and indicate below how/when you will return this important information.

I have returned the form by email

I will send the form by email soon

I'll bring the form printed to the clinic

I need a copy sent by email, please

I understand the Payment Method and Referral Options options and agree to make prompt payments *

Each service/session requires payment using one of the following options. Please select your preferred option and our admin team will support your occupational therapist in organising these payments promptly after each session/service. PLEASE NOTE - fees are to be privately paid after Funding options have expired.

EziDebit secure online payment

Invoice for direct debit (credit card or bank account)

Cash on the day

Medicare - GP Care Plan or EPC (also select your preferred payment method as rebates are claimed through medicare separately - MAX 5x each year)

Medicare - Mental Health Care Plan (only some OTs are registered for this rebate, please confirm with our team, MAX 20x each year)

NDIS Self-Managed (also select your preferred payment method)

NDIS Plan Managed

NDIA Managed

I understand that Early Links provide professional learning opportunities for University students *

When any University student is invited to attend a therapy session and/or meeting, they do so under the supervision (direct/indirect) of a qualified occupational therapist who has identified their skills as appropriate and their behaviour at a professional standard which supports and often increases the service outcomes.

I agree, university students can attend sessions when the Occupational Therapist chooses

I agree, university students can attend sessions when discussed specifically before each service

Unsure, further discussion is required with the Occupational Therapist before session

I understand that Early Links will record, store, and use personal health information in accordance with Australian National Laws *

Early Links uses an Australian Company to host secure and encrypted serves in Sydney. Information is password protected and any activity is logged digitally

I acknowledge that personal health information will be stored securely on encrypted servers online

I wish to discuss this further with a Clinical Manager

I understand that Early Links may record, store, and review multimedia from Occupational Therapy Sessions *

Sometimes having photographs, videos and/or audio from your therapy session can assist the Occupational Therapist to observe details more clearly and reflect on aspects of performance. These multimedia file are stored secure and will be deleted once clinical reviews are made. NO Multimedia collected from therapy sessions will be used for advertising. Staff will always alert you to any recordings taken during sessions.

I agree, multimedia can be collected, reviewed, and stored for the purposes of clinical observations and planning

Unsure, further discussion is required with the Occupational Therapist

Declaration *

The above information is accurate at the time of submitting this form. When/if any information changes, it is the responsibility of the client/caregiver to notify Early Links in writing (email to : info@earlylinks.com.au)

The information provided is correct and accurate