Private Referrals

To make a referral, please fill in our easy online form. Please call our friendly and helpful Care Squad on 1300 632 639 if you need assistance. Thank you for choosing Care Squared Kids. We look forward to supporting you.

Referrer(Required)

Referrer Phone Number(Required)

Referrer Email

Parent/Carer Name (if different to referrer)

Parent/Carer Number

Parent/Carer Email

Client Name(Required)

Date of Birth(Required)

DD dash MM dash YYYY

Address

Street Address City State / Province / Region ZIP / Postal Code

Phone Number

Has the Parent/Carer and/or Client consented to this referral being made?

Yes

Services Required

Exercise physiology

Occupational therapy

Physiotherapy

Positive behaviour support

Psychology

Speech pathology

How would you like to have support proivded?

Face to face

Telehealth/video call

Both

Service Location

Home

Kindergarten / school / daycare

Clinic / therapy suite

Other

Service Location

Private Health Fund?

How did you hear about us?

Other information as to services required?

This field is for validation purposes and should be left unchanged.

Contact Us

HEAD OFFICE
Building 1, Suite 4D
19 Lang Parade
Milton QLD 4064

1300 632 639

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We acknowledge the Traditional Custodians of the lands and waters upon which our services are provided. We acknowledge their continuing connections to country and we pay our respects to Elders past, present and emerging.

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