Children's Wellness Consultations
Thank you for enquiring into some care and support for your little one.

Please complete this form on behalf of your child (with their details), so that I can better understand how I can help you/your family.

Consultations are booked as a minimum package of 'one initial consultation and one follow up consultation' (valued at $250.00, inclusive of the two consultations) for ALL childhood wellness bookings; this is to ensure the very best care and outcome for your child.

If you would like to discuss multiple family members or a whole family wellness program, please complete the questions below on behalf of the child whom you feel you would love the most urgent care for.
There is additional space under an 'Other Family Members' heading, provided for you to let me know about who else is in the family and any other concerns.

I'm looking forward to getting to know you better, Katie.
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Email *
Child's Full Name *
Child's D.O.B *
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/
DD
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YYYY
Your Name (Caregiver/Parent) + Relationship to Child *
Phone Contact *
Home Address/Postal Address *
Area of Focus/Primary Health Concern (what is it that prompted you to be in touch)? *
Child's Previous Medical History (please list all previous medical history inclusive of pregnancy, birth, infancy). *
Any Medications/Supplements (please list dosages and length of time prescribed/used) *
Please tell me about any previous care you have sought regarding your concerns. What has worked/hasn't worked for your child so far? *
Please tell me about your child's main symptoms (you may like to mention your child's sleep, behaviour, immunity, toileting habits, food habits or other symptoms like any pain you've noted). *
Does your little one have any known allergies or intolerances? What happens when they are exposed? *
Other Family Members (please let me know here about any additional members of the family you would love support for and what is concerning you). *
Thank you, we'll be in touch as soon as possible.
You will receive an personal email reply to this form discussing your needs.

If we don't need some extra help from you in organising an individualised plan for your family (i.e. for example to assist multiple family members or more complex needs) , you will be offered a choice of the next available appointment times and a link for the payment process so you can secure this for your child.

Consultations are currently hosted via Zoom video call which we can assist you with if that's new to you.
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