Referrals — MightyKids Rehab

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Referrals

About us Our People Services Hydrotherapy Events FAQs Locations Contact

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Referrals

To request an appointment, please complete the required fields below to send a referral to our MightyKids Rehab team:

Referrers details *

First Name

Last Name

Name of practice/service:

Role

Referrers phone number *

Name of child/client/patient *

First Name

Last Name

Date of birth *

Month day format

MM

DD

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Name of guardian *

Relationship

Parent/relative/caregiver

Phone number *

Email

Clinical details *

Reason for referral (tick as many as needed)

Management of abnormal muscle tone, posture or movement

Medication recommendations

Orthotic assessment/review

Gait assessment

Equipment issues

Care coordination

Recent deterioration or complications

Diagnostic uncertainty

Pain

Fatigue

Other information

Thank you! Your referral has been received.

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Email Address

Thank you!

Partners

Auckland neurorehabilitation

Specialists

CSPR Limited