OTRS Consent Forms

Our Occupational Therapists will always obtain your written consent before proceeding with any assessment.

They will explain the assessment process, discuss the consent form and obtain your signature as your approval to participate in the assessment. You will be provided with a copy of the signed consent form.

If you wish to review the consent form before your assessment, please click here for the Fitness to Drive Consent Form or here for the Transport Consent Form.

Get in touch:

Phone: 0800 687 748

Fax: 07 838 0152

Email: info@otrs.co.nz

Address: Hamilton

Suite 3, Level 1

169 London Street,

Hamilton Central, 3204

For clinicians only:

Make a referral:

Patient Name

Street Address

Town or City

Phone Number

Additional Contact Details: (Mobile Numbers and Email Address)

Date of Birth

Diagnosis

Reason for referral (please include MOCA or MINI ACE score and current medications list) GP please email these to info@otrs.co.nz or fax any other relevant information to 07 838 0152

Additional Comments or Concerns

GP or Specialist Name and Designation

Clinic or Practice Name

GP or Specialist email address

GP or Specialist Contact Number

Please tick if receipt of referral or a copy of the referral is required

Address

Thank you, your referral has been sent successfully and the OTRS Team will be in touch to arrange your assessment. A report will be sent once the assessment has been completed.

OTRS Consent Forms

Get in touch:

For clinicians only:

Make a referral:

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