Contact Form

If you are interested in accessing our services, please complete the contact form and we will endeavour to get back to you as soon as possible.

Contact Form

Your Name*
First Last
Email*
Contact Phone Number
Residential Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Child’s Name*
Name
Child’s Date of Birth*
DD slash MM slash YYYY
Child’s Diagnosis*
Child’s NDIS number
Self-managed NDIS plan
- Yes
- No
- N/A
Has your child’s diagnosis been confirmed by a medical specialist?*
Current services your child receives
Message
Attachments (letters or reports)
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I consent to the privacy policy*
- Yes
View the privacy policy here
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Disclosure
Any information we collect from your child will remain confidential. We will not disclose your personal information to a third party without your consent, unless we are required or authorised to do so by law or other regulation. In the event of an investigation into suspected unlawful or improper activity, a law enforcement agency or government agency may exercise its legal authority to inspect the web server's records (e.g.. in relation to hacking or abusive messages).

Address
CPTherapy
74 Faraday Street
CARLTON VIC 3053
Phone
+61 404 652 336
Email
admin@cptherapy.org
Operating Hours
Monday to Thursday 8:00am to 6:00pm

Contact Form

Contact Form

Address

Phone

Email

Operating Hours

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