School referral form for Physiotherapy

Physiotherapy is aimed at supporting children’s physical development and movement skills. If you have noticed concerns with balance, coordination, strength, or overall mobility, this form enables you to share details about the challenges your student may be facing. The information you provide serves as the initial step to DST following up your expression of interest for our physiotherapy services, noting the information below.
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.