EL Client Information

Request for Therapy Supports

Please complete this form to request support from our services.

When your request is received we will send you an email to confirm your place on the waitlist.

If you have not heard from our office after a week please email enquiries@enhancinglearning.com.au

If you need assistance completing this form please call (08) 6140 3919.

Please note we are a paediatric service and currently only have capacity for clients from 0 - 10 years.

Child's First Name *

Child's Last Name *

Child's Date of Birth

Name of Primary Caregiver(s) *

Best email contact *

Best Phone Contact

Secondary Phone Contact

Your Address

How can we help? *Unfortunately, our Mandurah location does not provide mealtime therapy services. Please contact our Osborne Park location.

How will you access our support? *

We will privately pay for sessions and claim any rebates we can through private health insurance We have a Medicare Plan - Please note we do not bulk bill, you MUST pay a gap for this serviceWe have an NDIS plan that a plan manager supports us withWe self manage an NDIS planWe are not sure and would like your advice

Not sure of your options to access our services - see options here

Please note gaps apply for all private health insurance and Medicare programs. Some GPs have been stating medicare sessions are free - this is not the case.

You will need to pay the full amount on the day and claim back from your private health insurer or medicare.

We DO NOT bulk bill for medicare

I understand I need to pay in full and seek any portion of my payment back from private health or medicare if I have access to either of these options *

Your GP Details (only required if you have a Medicare CDMP)

Your Private Health Insurer (so that we can ensure the correct codes are on your invoice)

To help us understand you child's support needs - Please provide some more information

We need a few more details - the more information you can provide us at this stage the better we can plan the best possible service plan for your child.

For example it may be that you are just wanting an assessment because you are not sure if your childs' skills are developing typically. We can then match you to a single assessment session to check this and discuss any next steps at that time.

However if your child has identified needs or you are very concerned about their development we will work out a service plan that help get that started as quickly as possible.

Have you been accessing any other supports to help with this up until now? Any other therapists or assessments we should be aware of?

Name of Daycare or School your Child Attends

If your child is at Kindy, please indicate the days they attend.

Tell us about how we can support you and your child - what are you concerned about?

What are they good at and what do they love to do?

Please indicate the type of support you are looking for (you can tick as many boxes as necessary)

Only require an Initial Assessment at this stageRequire ongoing therapy supportInterested in groups/classes at the centreInterested in additional support provided by our Allied Health Assistants Interested in school/daycare visits

You can upload documents here e.g. Medicare Plan, assessments, doctors reports, school letters or reports

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Please upload your NDIS Plan here if you wish to - you can provide this to us when we make an appointment. Feel free to just upload the NDIS goals for your child - this gives us with a good idea of the supports they need.

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Thank you for all of your information.

We look forward to meeting your family.

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