Entry Form

2025 Pricing Guide & Intake Information

Please note that all new clients must complete an initial intake session with a Capacity Building Practitioner as the first step. This session is billed at a minimum of $420.19, and includes a follow-up informal report based on your needs.

OT and SP consult sessions: $258.59

Ongoing therapy sessions: $193.99 per hour (typically 1.17 hours)

For full details, please see our current Price List for 2025.

Important Notice: Cancellation Policy

Please read carefully before proceeding.

All appointments require a minimum of 3 business days’ notice for cancellations or rescheduling.
If notice is not provided within this timeframe, a 100% cancellation fee will be charged.

We appreciate your understanding and cooperation in helping us provide timely and effective services.

For full details, please review our Payment and Cancellation Policy.

SUPPORT PATHWAY

What Services are you seeking? *

Occupational TherapyBehavioural SupportSpeech PathologyOther

Are you interested in group programs? *

YesNo

PARTICIPANT/CHILDS DETAILS

First Name *

Last Name *

Preferred Name

Date of Birth *

Gender *

MaleFemaleOther

Pronouns *

he/him/his/himselfshe/her/hers/herselfthey/them/their/theirselfother

ATSI *

AboriginalTorres Strait IslanderAboriginal and Torres Strait IslanderNone of the Above

Culture

English is a Second Language

YesNo

CONTACT DETAILS

Contact Number *

Email *

Address *

Postcode *

City / Suburb *

State *

NEXT OF KIN CONTACT DETAILS

Name *

Phone *

Email *

Work Phone

Address

Postcode

City / Suburb

State

This person is to be the emergency contact person for the consumer.
If not please inform us of an alternative contact person.

Referrer

Refer's Name

Referrer Email Address

Family Doctor/ Regular General Practitioner Name

Family Doctor Practice

MEDICARE

Do you use a different name in your medicare card?

YesNo

If you use Alias please write the Alias name & surname

Medicare First Name

Medicare Surname

Medicare Card No.

Individual Reference Number

Expiry

Medicare Address (if different to your residential address)

PRIVATE HEALTH INSURANCE

Do you have private Medical insurance *

YesNo

Provider

Membership No.

Expiry

NDIS PLAN DETAILS

Do you have an NDIS support plan *

YesNo

Please note that we are not currently taking NDIA managed NDIS plans. If you have an NDIA managed plan and are seeking Occupational Therapy please inform us via email and we will inform you if we start taking on NDIA managed plans.

Participant Number *

Start Date *

End Date *

Do You have a Support Coordinator *

YesNo

Support Coordinator *

Support Coordinator Contact Number *

Support Coordinator Email Address *

Funding Type *

Plan-ManagedSelf-Managed

Plan Manager *

Plan Manager Email *

READ BEFORE PROCEEDING: NDIS Plan and supporting documents. Please note we require the full NDIS plan before booking appointments *

Browse

GOALS FOR SERVICE

Brief description of support required *

Any other supporting documents

Browse

CHILD SAFETY AND WELLBEING

Our Commitment to Children's Safety and Wellbeing

At Collective Growth, we are unwavering in our commitment to the safety, wellbeing, and empowerment of all children and young people. We believe every child has the right to feel safe, be heard, and thrive in an environment that respects their dignity and individuality.

We prioritise children’s safety in every aspect of our work. This means:

Embedding child safety into our leadership, governance, and daily operations.
Maintaining a zero-tolerance approach to child abuse, neglect, and harm in any form.
Proactively identifying and managing risks to children’s safety and wellbeing.
Ensuring all staff, volunteers, and contractors are trained, supported, and held accountable for upholding child safe practices.

We affirm our commitment to listening to and empowering children by:

Actively seeking and valuing their voices in decisions that affect them.
Providing age-appropriate, culturally safe, and inclusive ways for children to express their views, concerns, and feedback.
Ensuring children are informed of their rights and supported to exercise them.

We are dedicated to creating a culture where children feel seen, heard, and valued – where their safety is not only protected but championed.

Working Together to Keep Children Safe

We believe that safeguarding children is a shared responsibility. We welcome and value the input of all those involved in a child’s care at our clinic. Your insights help shape our policies and practices, and we encourage you to speak up if you ever have concerns about a child’s safety or wellbeing in our space.For more information on our Child Safe Standards and how to provide feedback, please visit our website.

SIGNATURE & AGREEMENT TO POLICIES

I confirm that above information I have provided is true, complete and accurate. *

Agreement to Policies

By submitting this form, you acknowledge and agree to have read and understood our policies, including:

Privacy Policy | Payment and Cancellation Policy(Note: Cancellations require 3 business days' notice; otherwise, a 100% fee applies.) | Price List | Collective Growth

Please review these policies before proceeding on our website below:

Collective Growth | Gladstone Central

Parent / Guardian / Support Coordinator / Referrer Signature *

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Today's Date *

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