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  • Home
  • About Us
    • About DSKC
    • Meet the Team
    • Locations
      • Mill Park Clinic
      • South Morang Clinic
      • Mobile Service
      • View all Locations
    • Referrals
  • Services
    • Autism Spectrum Assessment
    • Group Therapy
    • Occupational Therapy
    • Psychology
    • Speech Pathology
    • Mobile Service
  • NDIS
  • Careers
    • View Open Roles
    • Graduate Program
    • Senior Therapist Program
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OT Intake form

Occupational Therapy
Inclusion Criteria Exclusion Criteria
  • Paediatric Clients, aged 2-17 years of age.
  • Clients experiencing functional difficulties that negatively impact their participation in everyday life.
  • Basic (Level 1) and Standard (Level 2) Assistive Technology.
  • Functional Assessments if NDIS has requested, or Allied Health Professional (Speech etc.) deems client to need more funding.
  • Sensory assessment and recommendations if there are ongoing sessions.
  • Behaviour management referrals with complex mental health or behavioural difficulties, without an actively involved lead mental health clinician and no functional difficulties are outlined.
  • Toileting referrals as the sole concern.
  • Physical disabilities; Cerebral palsy, Pigeon toed and Gait issues - Contact Physio or specialised OT.
  • Complex Assistive Technology and Home Modification (Level 3 and 4) solutions, such as ramps and structural changes to building.
  • Hand Therapy and Splinting referrals.
  • Driving Assessments.
  • Equipment prescriptions (Wheelchairs).
  • Developing Behaviour Support Plans - Refer to Behaviour Support Practitioner.
  • Accessing services using "Better Access to Mental Health Plan".
  • No functional goals identified.
Please understand that our OT’s do not work with the presentations in the exclusion criteria above. Please tick the box below to confirm your understanding of exclusion criteria:(Required)
Please see OT Australia’s “find an OT” page for specialisations

Client’s Details

Child's Full Name(Required)
Address(Required)
DD slash MM slash YYYY
(School, Childcare, Kinder)
(Diagnoses, Medications)

Preferred Contact Person Detail

Funding Details

Funding Type
DD slash MM slash YYYY
DD slash MM slash YYYY
How are the NDIS Funds managed?
(if applicable)
Drop files here or
Max. file size: 256 MB.
    Are there any family court orders in place?
    Drop files here or
    Max. file size: 256 MB.
      Child lives with:

      Provision: Services Sought (Pick one, both or skip if unsure)

      Assessment
      Intervention
      (if known)
      (if required)
      Preferred Session Frequency

      Format of sessions
      Reason for Referral/Summary of Concerns?
      (Please provide as much detail as possible)

      Referrer Details

      Referral Source
      DD slash MM slash YYYY
      How did you hear about De Silva Kids Clinic?

      NDIS Service Agreement Notice


      You have selected NDIS funding. You will now be redirected to the NDIS Service Agreement for your review and authorisation.
      We’re sorry 😢
      We’re sorry, but we’re unable to process your form submission as it appears you are not a parent and/or have not confirmed that you have read and understood the inclusion and exclusion criteria.
      Please review the criteria carefully and try again. Thank you!

      Healthy Kids,
      Happy Families

      At De Silva Kids Clinic, we believe that a healthy child is the foundation of a happy family. Our holistic approach and family-centered care ensure that your child feels supported, empowered, and ready to embrace every milestone. Book an appointment today to start the journey.

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      Our Locations

      Come Visit Us

      Mill Park Clinic

      A welcoming space equipped with a state-of-the-art sensory gym and advanced therapy tools to support your child’s growth and development.

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      South Morang Clinic

      Offering a friendly and inclusive environment where our multidisciplinary team provides tailored care for every child.
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      Mobile Therapy

      Bringing our expert care to the comfort of your home, ensuring your child receives the support they need, wherever they are.
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      • 03 8418 8544
      • Mill Park 0426 776 028
      • 03 8418 8545
      • info@desilvakc.com

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      Services

      • Mobile Therapy
      • Autism Spectrum Disorder (ASD) Support
      • Speech Pathology
      • Occupational Therapy
      • Psychology
      • Group Therapy
      • Mobile Therapy
      • Autism Spectrum Disorder (ASD) Support
      • Speech Pathology
      • Occupational Therapy
      • Psychology
      • Group Therapy

      Locations

      • Mill Park Branch

      217 Childs Rd, Mill Park VIC 3082

      De Silva Kids Clinic acknowledges the Traditional Owners of the lands on which our services are located.
We honour the strength and resilience of Aboriginal and Torres Strait Islander peoples and pay our respects to all Elders, past and present.

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