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Make a referral

COVID-19 Updates

Information about Coronavirus and Kites Children’s Therapy services

Referrals

Main Content

Kites accepts referrals from parents, carers, family members, allied health professionals, GPs and other specialists.

To get started with your referral to Kites therapy, please fill in our easy online referral form below. If you have information about your child or patient’s diagnosis or medical history, keep it handy to supply with your application.

Don’t like filling in forms? No worries! Call us on 9311 8222 and we’ll take care of everything you need to get you started on your Kites journey today.

Therapy for Children & Youth Referral Form

Details of child

Address
Address
Suburb
State
Postcode
Australian Residency Status *

Details of parents(s) / guardian(s)

Is this person the child's legal guardian?
Parent/guardian 1 address *
Address
Address
Suburb
State
Postcode
Country
Is this person the child's legal guardian?
Parent/guardian 2 address
Address
Address
Suburb
State
Postcode

Details of referral

Please attach copies of diagnostic reports (if available)
Maximum upload size: 10MB
Attach up to three PDF or Word documents. Maximum upload size is 10 Mb.
Does your child engage in any behaviours that may compromise the safety of our therapy dog?

Contact details for referee

Complete this section only if the referee is not the parent
Declaration *
Privacy Collection Notice

EverAbility Group Ltd is collecting your personal information so we can respond to your enquiry. You can read more about how we deal with your personal information in our Privacy, Dignity and Confidentiality Policy which you can access via the EverAbility website.