OTRS Consent Forms

Our Occupational Therapists will always obtain your written consent before proceeding with any assessment.

They will explain the assessment process, discuss the consent form and obtain your signature as your approval to participate in the assessment. You will be provided with a copy of the signed consent form.

If you wish to review the consent form before your assessment, please click here for the Fitness to Drive Consent Form or here for the Transport Consent Form.

Get in touch:

Phone: 0800 687 748

Email: [email protected]

Address:

Hamilton

Suite 3, Level 1

169 London Street,

Hamilton Central, 3204

Wellington

65 Waterloo Road

Hutt Central

Lower Hutt, 5010

For clinicians only:

Make a referral:

Patient Name(Required)

Street Address(Required)

Town or City(Required)

Phone Number(Required)

Additional Contact Details: (Mobile Numbers and Email Address)

Date of Birth

Diagnosis(Required)

Reason for referral (please include MOCA or MINI ACE score and current medications list) GP please email these to [email protected] or fax any other relevant information to 07 838 0152(Required)

Additional Comments or Concerns

GP or Specialist Name and Designation(Required)

Clinic or Practice Name(Required)

GP or Specialist email address(Required)

GP or Specialist Contact Number(Required)

Please tick if receipt of referral or a copy of the referral is required

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Comments

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