1    Pre-school and primary school intake form for Therapy
Please note Kidz Therapy practitioners operate under a Code of Ethics and adhere to the Privacy Act of 2020.  To provide us with the best information to support the child please respond to all questions as clearly as you can.
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Name of the Psychologist/Therapist who will see your child at the initial appointment *
Date of initial visit
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Current School and Year level
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