Tele-Transition Program Registration

Participant name*

First Last

Participant Date of Birth*

Is the participant a Therapy Focus customer?*

Yes
No

Parent/Guardian Name*

First Last

Phone*

Email*

What is your preferred program dates/times?*

Please select your top 3 preferences.

How would you like to purchase this program?*

Participant's NDIS Number*

NDIS Plan Start Date*

NDIS Plan End Date*

Does the participant have a behaviour support plan in place?*

Yes
No

Comments:

Is the participant able to follow written and verbal instructions in a group setting?*

Yes
No

Comments:

Has the participant taken part in a group therapy session previously?*

Yes
No

Does the participant have access to a computer or tablet with Microsoft Teams?*

Yes
No

Is the participant able to independently access a computer and Microsoft Teams?*

Yes
No

Does the participant have the computer skills to follow a link and use a search engine?*

Yes
No

Does the participants NDIS Plan include goals related to developing one or more of the following areas; transition to adulthood, employment, education, finances, health, housing, relationships or leisure?*

Yes
No

If yes, please specify the goals:

What do you / the participant hope to gain from the program?

Phone

This field is for validation purposes and should be left unchanged.

What are you looking for?

Tele-Transition

Register your interest