School referral form for Occupational Therapy

Occupational Therapy (OT) focuses on helping children develop the skills they need to perform daily activities with confidence and independence. If you have noticed challenges in a student’s ability to participate in tasks like self-care, play, or school activities, this form allows you to share specific observations and concerns. The information you provide will help us tailor our approach to support the student’s functional skills, sensory processing, and fine and gross motor development.
Please note, you will be required to include contact details for the student's caregiver before submitting this form (Name, Phone, and Email). You will also be asked to confirm that consent has been obtained for this referral. Please ensure you have this information prior to completing the form.