Let’s work together

Thank you for trusting Siobhan at Me and My OT as your Occupational Therapist. After filling in the below referral form, I will be in touch with you shortly after.

Client Details

First Name

Last Name

Phone

(###)

###

####

OT service required?

Functional Capacity Assessment (15 hours)

SIL/ILO (18 hours)

SDA (20 hours)

Assistive Technology Assessment (8 hours)

Daily Living Skills / Ongoing Therapy (15 hours)

Minor Home Modifications (10 hours)

Date of Birth:

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

NDIS Number:

Plan Manager:

Any other details relevant to referral?

Referrals and funding

Referrals to Me and My OT are accepted via email or website referral page directly from clients, client’s family, GP’s, support coordinators or any stakeholders involved in the clients’ care.
Please also reach out via phone if you would prefer.
Email: siobhan@meandmyot.com Phone: 0487 168 333
FUNDING AND FEES
Me and My OT offer services to the through the below funding pathways:
NDIS – plan managed and self-managed
Me and My OT set their fees according to the NDIS price guide of $193.99 per hour. This fee is for all services.

Referral

Let’s work together

Referrals and funding