For Referrers

Referrers Details *

First Name

Last Name

Child's Name *

First Name

Last Name

Child's Date of Birth *

MM

DD

YYYY

Child's Parent/Guardian/Carer *

First Name

Last Name

Who should we send the intake form to for completion? *

Referrer

Child's Parent/Guardian/Carer

Quotation for 15 Hours of Play Therapy *

These sessions occur weekly and are 50 minutes each, allowing for an additional 10 minutes of parent consultation following the session. Included in these 15 hours would be: - An Initial parent/carer consultation - 12 Play Therapy Sessions - 2 Additional Hours for parent/carer support meetings/report writing/external observations/ attendance of care team meetings 15 Hours Total Cost; $3,150.00 Please note: We do not send quotes for less than 15 hours of Play Therapy. Due to the nature of the work that we do with our clients, we need to spend time to build a sense of safety in the playroom, as well as building a strong rapport with the child and their support system. We also need to ensure that the child has an appropriate therapeutic ending and that therapy is not ended abruptly when the child is in the middle of processing. We are able to separate this package into two payments, of 5 sessions and then 10 sessions, to ensure suitability and engagement

I have read and agree to the above quote and conditions