Therapy Enquiry Form

Is this being completed by a Brain Train employee?

YesNo

Name of Person Completing this Form *

Contact Email Address *We need this for our records, so please enter your best contact email. Please check your junk mail if you have not received an email within 7 days.

Contact Mobile Number *Please enter your best contact Mobile number, if we can't reach you we will be sure to leave a voicemail and follow up with a text.

How did you hear about us? *We love specifics :)

Participant First Name *

Participant Last Name *

Participant Date of Birth *

Which centre are you interested in bringing the participant to? *

Choose your nearest timezone: *

Australia/BrisbaneAustralia/SydneyAustralia/Melbourne

*Please select this carefully to ensure it is accurate as this will impact your future bookings

Which therapies would you like to enquire about? **Remember, we may be able to offer telehealth services or home programs for some of our therapies if you do not live near one of our existing locations!

Does the participant require a Functional Capacity Assessment? *

NoYes

Please list your preferred days/times to attend therapy as well as anything else you would like us to know about the Participant: *(eg. diagnosis, reasons for seeking treatment, other therapies that participant is currently attending etc)

If you are interested in Brain Train's foundational Sensorimotor Therapy, we are happy to offer online bookings for our Free Consultation here, at participating locations.

We do not currently have direct online bookings available for our FREE CONSULTATIONS for our Burleigh Heads Centre via our Book Now page. If you are interested in any of our therapies and supports, please continue to complete the details above and submit this form and we will be in touch with you shortly about our availability! Our friendly team would also be more than happy to answer any questions that you may have about the new Centre opening or Sensorimotor Therapy.Please feel free to call them on 1300 209 634 or message us here.

We may have a waitlist in some locations for specific services. Please be assured that upon receipt of this form, your details will be added to the waitlist and our friendly Scheduling team will be in touch with you as soon as we have availability.

If you would like to avoid a delay in supports due to long waitlists, please contact us on 1300 209 634 or live chat with us in business hours here to discuss what other services or programs might be immediately available that can assist you in your therapy journey while you wait.