Appointment Request - Holistic Occupational Therapy | Vithurry Vaseeharan OT Reg. (Ont.)

First Name *

Last Name *

Parent/Guardian first and last name

Phone number *

Email *

Child's first and last name

Child's date of birth (DDMMYY)

Preferred method of contact?

Does your child have any formal diagnoses?

Thank you for your interest in our practice!

What is the reason for seeking occupational therapy services? *

What type of occupational therapy service(s) are you looking for? (virtual/in-home)

What day(s) of the week work best for an appointment? *

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What time of the day is usually better for you? *

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Is there anything else you would like to specify? (optional)