Start up form - Growing Minds Occupational Therapy

Contact Details

Primary Contact First Name

Primary Contact Last Name

Other Caregiver First Name

Other Caregiver Last Name

Primary Address

Phone

Client First Name

Client Last Name

DOB

Diagnosis

Other

Other Medical Information

Name of School and Year Level

Interests

Check List

I would like to receive SMS reminders and communications

I consent to being contacted in the case of an emergency

I would like to nominate another adult to receive SMS reminders and communications

Name

Relationship

Phone

Therapy Preferences

Therapy Type

Ongoing Therapy One-off Assessment

Therapy Location

Home School Other

Please Specify

Time slot preference

Morning During school hours Afternoon

Therapy Frequency

Weekly Fortnightly

How Fees will be Paid

How Fees Will be Paid

Private/Self NDIS

NDIS Number

How will Appointments be Funded

Agency Name

Phone

NDIS Plan Start Date

NDIS Plan Finish Date

*Sorry, we are unable to provide services to those with a Agency-managed NDIS plan.

NDIS Goals (Please enter your specific NDIS goals from your NDIS plan)

NDIS Goal 1

NDIS Goal 2

NDIS Goal 3

NDIS Goal 4

Additional NDIS goals

Pricing Guide

All services through Growing Minds Occupational Therapy are charged at the NDIS rate of $193.99 per hour. This includes;

Therapy sessions
Travel to and from sessions
Phone/email consultations
Teacher consultation and support
Resource creation
Report writing
Assessment related activities (i.e. scoring and report writing)
Team collaboration with external providers

Therapy sessions at Growing Minds Occupational Therapy are charged at 60 minutes, inclusive of 45 minutes contact time and 15 minutes of preparation/notes.

Service Terms and Conditions

At Growing Minds Occupational Therapy, we believe in providing our clients with informed and participatory services. Prior to the start of service delivery, we will ensure that all clients (and their parents/legal guardians) are fully informed about the services they will receive and obtain their informed consent.

Privacy, Confidentiality, and Information Sharing

Our staff at Growing Minds Occupational Therapy are bound by the Privacy Act 1988, Children and Young People (Safety) Act 2017, and the Ethical Code of Conduct set forth by occupational therapy professional regulatory bodies. We only collect and store personal and health information that is reasonably necessary for the following purposes:

Providing health care and wellbeing services to our clients
Contacting clients to provide advice or information regarding service delivery
Improving the quality of our services
Documenting service provision
Administering and managing services, including billing and debt collection
Ensuring continuity of care
Sharing information with responsible individuals, such as parents or guardians
Invoicing third parties
Complying with Australian law

We handle client information with sensitivity and are committed to maintaining client confidentiality and privacy. We take reasonable steps to securely collect, store, and use all client information. If any risks to clients or others are identified during service delivery, our staff members are legally obligated to report such risks under Australian Law.

Services for Clients under 18 and Family Involvement

At Growing Minds Occupational Therapy, we recognize the important role of parents/caregivers and family members in supporting children and young people during their therapeutic journey. We will work collaboratively with children, young people, and their families to ensure the best possible outcomes. During the initial session, our staff members will discuss information sharing and collaborative processes with you and your child, aiming to develop a plan that addresses your family's unique needs. With your permission, we may involve other relevant stakeholders, such as teachers, in the therapy process.

We prioritize the privacy of children and young people during service delivery. Progress updates may be provided to attending parents/caregivers, and non-attending parents can request treatment information. However, all shared information will be done in the best interest of the young person.

To provide effective services, it is crucial that we have up-to-date information about each client's circumstances. We kindly request that legal guardians provide relevant information in a timely and accurate manner, including any changes to the family unit or decision-making responsibilities related to living and healthcare. Unless there are court orders stating otherwise or reasonable suspicions of risk, both legal parents/guardians have equal rights to access services and information regarding their child. Our staff will interact with both parents respectfully and professionally, maintaining confidentiality throughout the service delivery process. We appreciate your cooperation.

Cancellation Policy

At Growing Minds Occupational Therapy, we require a 48-hour notice for cancellations. Failure to provide appropriate notice for 1:1 services will result in a cancellation fee equal to the full cost of the session. In the event of repeated non-attendance (3 consecutive instances without sufficient notice or less than 50% attendance to scheduled appointments), our staff reserve the right to discontinue services. If discontinuation is necessary, we will provide you with emergency contacts, external referrals, or place you back on the waitlist for services.

Rights and Responsibilities

Your Rights:

To always be treated with courtesy, respect, and understanding
To have your confidential information protected
To be consulted appropriately and make informed decisions for yourself or your young person
To provide feedback, voice concerns, or make complaints, with the assurance that they will be taken seriously and responded to promptly
To be communicated with openly and honestly
To receive fee schedules and the cancellation policy before the commencement of scheduled appointments
To receive services that comply with all relevant laws

Your Responsibilities:

To treat Growing Minds Occupational Therapy staff with courtesy and respect at all times
To provide your name and date of birth as required for identity confirmation (both caregivers)
To inform Growing Minds Occupational Therapy staff of any changes in custody arrangements or contact details
To communicate any concerns about the services being provided
To pay session fees in full on the day of the session or within 14 days if managed by a third party
Attendance at sessions indicates acceptance of the fee schedule
To cover any expenses incurred by debt collectors in recovering overdue amounts
To cancel the session if your child has a contagious ailment (e.g., gastroenteritis, head lice, etc.)
To adhere to the cancellation policy
To respect the rights of others
To ask questions if anything is unclear

I have read and understand the above information

Consent to Exchange Information

As part of our commitment to providing exceptional services and fostering collaboration with relevant parties involved in your care plan, we kindly request your authorization for Growing Minds Occupational Therapy to disclose and request information on your behalf.

Should you grant us permission, we will only seek or disclose information that is necessary and pertinent to your care plan, always acting in your best interests, and exclusively with individuals/agencies to whom you have granted consent to communicate with us. We will not share your personal information with anyone unless you have explicitly given us permission or when the disclosure is required or authorized by law.

Please note that your consent is voluntary, and if you decide at any time that you no longer wish for us to share your information or request information on your behalf from previously nominated individuals/agencies, you can withdraw your consent by contacting us. This can be done in writing or verbally.

At Growing Minds Occupational Therapy, we strive to uphold the rights of all children and young people, as outlined in the United Nations Convention on the Rights of the Child, throughout our service delivery. If you or your child would like a copy of this document, you can request it from our staff. We place great importance on your child's right to be informed about their treatment, information sharing, and to actively participate in their care plan and treatment journey. In addition to your consent, we will also seek your child's consent to share and disclose information whenever practical and appropriate. We will work together with you and your child to ensure a clear understanding of the information sharing processes, confidentiality, and any limitations to confidentiality (such as mandatory reporting obligations for our staff). Your child will be given an opportunity to express their views on this matter.

Furthermore, you have the option to include additional individuals/agencies on this form at any time if you believe it is crucial for us to request or disclose information on your behalf. This can be done in writing or verbally.

Signature Section

I the Primary Contact or Caregiver(s), give our consent for 'Growing Minds Occupation Therapy' as the parent/guardian for your Child to share and obtain information with the following service providers:

Do you have a Service Provider you would like to Add? (please ensure to add your school to ensure therapists are able to contact staff and arrange therapy sessions)