Make a referral

COVID-19 Updates

Information about Coronavirus and Kites Children’s Therapy services

Kites Referral Form

Main Content

Please complete our online referral form or contact one of our friendly Team Coordinators for further information. We will respond to all submitted referrals within two business days.

Fields marked with an asterix * indicate a required field.

Therapy for Children & Youth Referral Form

Details of child

Australian Residency Status *

Details of parents(s) / guardian(s)

Parent/guardian 1 address *
Parent/guardian 2 address

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 *