Therapy Appointment Registration

Please complete the registration form below. We will check suitability and therapist availability in your area and our team will be in touch.

Participant Details

Participant Nominee Details

Emergency Contact Details (optional)

How would you like to pay for your appointment?

NDIS funding management type

Which therapy service/s is your appointment for?*

Demographics Information*

Interpreter required

Any equipment or home/vehicle modification needs?

Preferred location for therapy?

How did you hear about Xavier?

* Indicates mandatory fields