“DC Kids” Clinic: September 14 –December 12, 2015
What?
The Occupational Therapist Assistant/ Physical Therapist Assistant(OTA/PTA) Program at Durham College will be offering Kids clinics fromSeptember 14- December 12, 2015.
The clinic will offer fine motor intervention to groups of children with fine motor delays.This service will offer an Occupational Therapist (OT) assessment during the first week, followed by weekly treatment sessions with the OTA/PTA students and under the direct supervision of the OT to implement the treatment plan.
Services will be provided free of charge, with a one-time administration fee of $30 for registration.
Who?
Children aged 4-10 with fine motor delays who consent to and can actively participate in group therapy with OTA/PTA students under the direction of an OT. Clients will be screened and allocated to an appropriate treatment group. It is expected that clients will participate for the 13 week duration. A waitlist will be created and maintained. Clients will be contacted as spots become open in treatment sessions.
Where?
Durham College OTA/PTA Lab, room F127
Parking will be provided on-site for program participants free of charge.
When?
Clinics will be offered Monday and Wednesday evenings from 6-8pm and Saturdays from 10am-12pm and 1pm-3pm. Participants will attend only one sessionper week for 13 weeks.
How?
Please complete the intake form and forward this to Durham College by Fax 905.721.3189, mail or in person to: School of Health and Community Services, Durham College, 2000 Simcoe Street N, Oshawa, On, Canada, L1H 7K4, to the attention of Teresa Avvampato.
You will be contacted by the College in September to confirm your acceptance and group dates/times for attendance. You will be required to attend the first session for the OT assessment in order to participate in the treatment sessions.
“DC Kids” Clinic: September 14 –December 12, 2015
Intake Form
Client name: ______(first and last)
Date of birth (d/m/y): ______Gender: ______
Guardian name:______Phone number:______
Email contact (to provide information regarding parking/clinic details:______
Home Address:______
1) Please list all medical diagnoses:______
2) Main reason for seeking treatment/ areas of concern: ______
3) Are you receiving or have you received other therapy services? If so, please provide a summary of those services: ______
4) I am able to attend (please check all that apply):
___ Monday 6-8pm___Wednesday 6-8pm___Saturday 10am-12pm ___Saturday 1-3pm
5) I am available for the full 13 weeks of treatment, one treatment session per week
____ Yes ___ No: please specify your availability/interest: ______
6) Referral source (how did you hear about this program):______
I understand that this service is intended for children aged 4-10 with fine motor delays who consent to and can actively participate in group therapy with OTA/PTA students under the direction of an OT. Clients will be screened and allocated to an appropriate treatment group. It is expected that clients will participate for the 9 week duration. A waitlist will be created and maintained. Clients will be contacted as spots become open in treatment sessions.
______
Guardian NameGuardian SignatureDate