Professional Referrals | Lok Si OT South-East Melbourne

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Professional Referrals

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Referral Information

We welcome referrals from healthcare professionals, educators, support coordinators, and community services.

Submit a Referral

After receiving your referral, we will review the information provided and contact the family or nominated contact person regarding next steps.

Professional Referral Form

Referrer Details

Referrer Name*

Organisation*

Role / Position*

Support Coordinator

Occupational Therapist

Speech Pathologist

Psychologist

Teacher / Educator

Early Childhood Professional

General Practitioner

Paediatrician

Allied Health Professional

Other

Email*

Phone

Child Details

Child's Name*

Child's Age or Date of Birth*

Suburb*

NDIS Participant*

Yes

No

In the process of applying

Unsure

Referral Information

Reason for Referral*

Areas of Concern*

Emotional regulation

Sensory processing

Fine motor skills

Gross motor skills

Self-care / daily living skills

School participation

Social skills

Play skills

Community participation

Behavioural concerns

Executive functioning

Other

Preferred Service Location*

Home

School

Kindergarten

Community

Unsure

Additional Information

Anything else you would like us to know?

I confirm that consent has been obtained from the parent/guardian to share this information and make this referral.

Strength-Based • Community-Based • Collaborative

loksiot@outlook.com

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