Register for Occupational Therapy

Please complete the registration form below, so we may  help you in the best possible way. The terms and conditions can be seen and downloaded here, on a new tab

Thank you for choosing FFL.

It takes  5 to 10 minutes to register. Please start by entering your own data.

I agree with the terms and conditions*

Your Information

Your relationship to child:*
Relationship to child*
Title*
First Name*
Last Name*
Email*
Phone*
Street*
City*
Post Code*
Country*
Is this the address for Invoice?*
Name for invoice*
Invoice Street*
Invoice City*
Invoice Post Code*
Invoice Country*
Invoice Email*
Invoice Delivery*

Please give us the details of a Second Adult  we can contact if you are not available.

Second person First Name*
Second Person Last Name*
Second contact Email*
Second Contact Phone*

Child Information

Child 1 First Name*
Child 1 Last Name*
Child 1 School
Child 1 Gender*
Child 1 Date of Birth*

dd-mm-yyyy is format


Child 1 Nationality*
Does this child live at your address?:*
Child 1 Street*
Child 1 City*
Child 1 Post Code*
Child 1 Country*
Register another child
Child 2 First Name*
Child 2 Last Name*
Child 2 Nationality*

Final Section

We would like to know your employer's name for our statistical purposes.  We sometimes contact companies to ask for funding and it helps us to be able to show how often our services have been used. We NEVER share names of clients or personal data and all your information is treated with complete confidentiality. 

Employer 1
Employer 2
Employer 3
Please tell us how you found us
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