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  • Home
  • About Little Hiccups
    • About Us
    • Case Studies
    • Welcome Pack
    • FAQ
    • Meet The Team
    • Awards and Certifications
    • Supporters and Affiliates
    • Policies and Procedures
    • General Feedback Form
  • How We Support
    • –
      • Stay n’ Play
      • Family Fun Days
      • Parent/Carer Events
      • Hydrotherapy
      • Physiotherapy Support
      • All Terrain Buggy Hire
    • –
      • Travel Bed Hire
      • Stabilo Bagel Hire
      • Counselling
      • Compassion Packs
      • Mosaic Trail
      • Max Card
    • –
      • Educational / Informative
      • The Principle Trust Holidays
      • Ison Harrison Solicitors – Making a Will
      • Other Information
  • Get Involved
    • Volunteering
    • Fundraising
    • Corporate Sponsorship
    • Charity Lottery
    • Will Legacy
    • Give As You Live
    • Nectar Donate
    • Donate
  • Upcoming Events
    • All Events
    • Family Fun Days
    • Parent/Carer Events
    • Stay n’ Play
    • Educational / Informative
    • Fundraising
    • Annual Charity Ball
  • Blog
  • Contact
  • DONATE
  • Store
    • Shop at Little Hiccups
    • Cart
    • Checkout
  • Login
    • Login/Register
    • Update My Details

Physiotherapy Assessment Booking Form

You should only complete this page if you have already signed up and confirmed a slot.
 
If not, you can find more info and sign up here. 
Thank you for signing up to a booking slot for our Physiotherapy Assessment Booking Form.
 
The below form will need completing before your visit. If you have any questions, please email info@littlehiccups.co.uk
 
Thank you.

Physiotherapy Assessment Booking Form

 

    Physio Assessment Form

    1. Booking Details


    2. Child's Details



    3. Parent/Carer Details


    4. Initial Assessment

    Were there any issues at birth?

    Did your child meet normal milestones?

    (e.g. lifting head, sitting, standing, walking)


    History of illness or surgery?

    Any epilepsy, chest, or heart conditions?

    Does your child suffer with pain or discomfort?

    (e.g. speech, sounds, smiles, signing)

    Who are the important people in your child’s life?

    5. Consent & Signature

    View Terms and Conditions (PDF)

    I certify the information is correct and consent to the Physio Assessment sessions. I confirm I will attend (unforeseen circumstances aside) and understand children must be supervised at all times.

    Login Status

    Forgot?  Register

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    Upcoming Events

    Hydrotherapy Sessions - Feb 2026
    Hydrotherapy Sessions - Feb 2026
    21 Feb 26
    Leeds
    2026 02 Drama for the Heart
    2026 02 Drama for the Heart
    27 Feb 26
    Leeds
    Stay n Play - Monday morning session - CANCELLED
    Stay n Play - Monday morning session - CANCELLED
    16 Mar 26
    Leeds
    2026 03 17 Lunch & Learn: Preparing for Adulthood – Employment Rights & Support for Young People with Additional Needs
    2026 03 17 Lunch & Learn: Preparing for Adulthood – Employment Rights & Support for Young People with Additional Needs
    17 Mar 26
    Online
    Stay n Play - Thursday afternoon session & My World, My Story, My Song
    Stay n Play - Thursday afternoon session & My World, My Story, My Song
    19 Mar 26
    Leeds

    Fresh from our Blog

    • Farmyard Fun and Hilarious Histrionics: A Week at Drama for the Heart!
    • Succulents, Soil, and Zero Stress: Our Team Night with the Queen of Green
    • Laughter, Germs, and Human Washing Machines: Drama for the Heart Week 1!
    • Sweet Success: Our Messy, Magical Chocolate Masterclass!
    • Pure Imagination (and a Little Bit of Chaos!)

    Get to know us

    Little Hiccups is a Leeds based support group that has been set up by parents who have children with additional needs.

    Through personal experience they recognise the importance of allowing the parents and families of a child with a disability the opportunity to meet people in similar situations, to make friends and support each other.

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    Contact Info

    • Little Hiccups
    • c/o The Barrowbys, 170 Barrowby Lane, Garforth, Leeds, LS25 1NG
    • 07831230741
    • info@littlehiccups.co.uk
    • https://www.littlehiccups.co.uk

    Charity Details

    Little Hiccups is a Company limited by Guarantee - Company number 09692276

    Little Hiccups is a Registered Charity
    Charity Number 1170147

    Blog

    • Farmyard Fun and Hilarious Histrionics: A Week at Drama for the Heart! March 9, 2026
    • Succulents, Soil, and Zero Stress: Our Team Night with the Queen of Green March 2, 2026
    • Laughter, Germs, and Human Washing Machines: Drama for the Heart Week 1! February 27, 2026
    • Sweet Success: Our Messy, Magical Chocolate Masterclass! February 23, 2026
    • Pure Imagination (and a Little Bit of Chaos!) February 18, 2026

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