Make a referral

Dog-Assisted Occupational Therapy

Dog-Assisted Therapy sessions run across an 8 week block, led by a qualifed Occupational Therapist with the support of a trained Therapy Dog. Find out more today.

Kites Referral Form

Main Content

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

Fields marked with an asterisk * 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

Reason for referral

Please attach copies of diagnostic reports (or other relevant information)

Maximum file size: 10MB

Attach up to three PDF or Word documents. Maximum upload size is 10 Mb.
Type of therapy requested
Does your child engage in any behaviours that may compromise the safety of our therapy dog?

Contact details of Referrer

Complete this section only if the referrer is not the parent
Declaration *