'Ohana Discovery Visit

'Ohana Discovery Visit

Aloha! Thank you for your interest in scheduling a Discovery Visit with us! Please fill out the form below so we can learn a little bit about you and your family and better learn how we can meet your needs. Our goal at 'Ohana is to help your family THRIVE!
Name (parent/guardian)*

First NameLast Name
Email*
example@example.com
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Child's Name*

First NameLast Name
DOB*

MonthDayYear
Date
Child's Age*
Child's Primary Care Doctor*
Insurance Provider
Please tell us about your child and your primary concerns*
Are you interested in learning more about the Wellness Services we offer at 'Ohana OT?

YesNo
I prefer to have my Discovery Visit

in the clinicvia phone
How did you hear about 'Ohana?
Please note that Discovery Visits are a complimentary visit that serves as a screening to determine whether your child may benefit from occupational therapy services. During the Discovery Visit, your child may be observed performing certain activities, and primitive reflexes may be screened. Please note that this is NOT a formal occupational therapy Evaluation.

I understand
Thank you for completing the form!
If you are not already scheduled, we will contact you
soon to schedule your Discovery Visit.

Mahalo!
Should be Empty: