Early Years Screen

Booking Form

The process from here

We'll ask for some general information about your child and you in this form, including name, date of birth etc.
When you click submit at the end of the form, you will be taken to a booking page where you can slect a time most conveinant for you to complete the Screen at our Lathlain Clinic. The screen is 45 minutes in total.
After booking in a time, we send you an email to help you prepare, which will include a a pre-assessment questionnaire to complete prior to the Screen. Your clinician will use this questionnaire alongside what they observe during your child's screening session.
We will send you a written summary of the screen, with tailored recommendations, and call you to walk through it.

About your child

First Name *

Last Name *

Preferred Name

Date of birth *

Pronouns (if known)

Daycare/Kindy/School *Include the name of the setting and days attended

GP / Paediatrician (if any)

agr_id

About you

The person filling in this form

Full Name *

Relationship to child *

Phone number *

Email *

Terms and Conditions and Form Submission

I understand and agree to BlueRocket Therapy's Terms and Conditions of Service, including the cancellation policy, which requires at least two business days' notice to avoid being charged for a session. *

I understand and agree to BlueRocket Therapy's privacy policy accessible at https://bluerockettherapy.com.au/privacy-policy *

Please click the submit button below to complete this form. You'll then be taken to a booking page where you can schedule your Early Years screen at a time that suits you.

Save and Complete Later