Appointment cancellation
Child's First Name
*
Child's Last Name
*
Location
*
Melbourne
Sydney
Therapy session was due to be:
*
clinic-based
community-based
assessment session - admin will contact you to reschedule
Date of appointment to cancel:
*
Appointment was due to be with:
*
Sophie Clune
Tameka Day
Emily Engelbrecht
Ella Flemming
Eloise Gray
Renee MacKay
Mary Ryan
Megan Stagoll
Sarah Zaidel
Not sure
Appointment was due to be with
*
Sophie Forsythe
Aleisha Hyslop
Charlie Kenna
Elle Millward
Charlotte Murdoch Evans
Michelle To
Maddie Vincent
Amanda MacLean
Not sure
If your cancellation is outside the 48-hour period, there will be no charge. If it falls inside this time, would you like a replacement service instead of the session?
*
N/A
Yes- I'll leave it to the therapist to decide what is most needed
Parent call at the same time the session was scheduled
Telehealth session with child (not guaranteed- admin will advise if this is possible)
Client review (Therapist will review goals and/or reach out to MDT)
Documentation- commence any reports or progress letters required
Create resources
No thankyou
Is there anything else you would like us to know regarding this cancellation, or the requested replacement service?
Name of person completing this form
Email Address
Date completing the form
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