CPotential Summer Intensive Block

Please complete the form to register your interest

We are excited to be running four weeks of intensive therapies during the summer holidays, from Monday 2nd – Friday 27th August. During these four weeks, we will be running Physiotherapy, Occupational Therapy and Sensory Integration and Conductive Education Sessions.

All sessions will take place at CPotential, 143 Coppetts Road, London, N10 1JP. Please complete the form below to register your interest in attending the sessions before the deadline of Monday 21st June and we will be in touch after this date to discuss scheduling your sessions.

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* 1. Please let us know the following information:

Your first name

Your second name

Email address

Phone number

Postcode

Child’s first name

Child's second name

Child's date of birth

Diagnosis

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* 2. Which week(s) are you interested in booking? Please select all applicable:

Week one: 2nd – 6th August

Week two: 9th – 13th August

Week three: 16th – 20th August

Week four: 23rd – 27th August

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* 3. If you selected that you would like to attend week one (2nd - 6th August) please select the service(s) that you would like to attend, or skip to the next question:

Physiotherapy

Occupational Therapy and Sensory Integration

Conductive Education individual session

Conductive Education group session

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* 4. If you selected that you would like to attend week two (9th - 13th August) please select the service(s) that you would like to attend, or skip to the next question:

Physiotherapy

Occupational Therapy and Sensory Integration

Conductive Education individual session

Conductive Education group session

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* 5. If you selected that you would like to attend week three (16th - 20th August) please select the service(s) that you would like to attend, or skip to the next question:

Physiotherapy

Occupational Therapy and Sensory Integration

Conductive Education individual session

Conductive Education group session

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* 6. If you selected that you would like to attend week four (23rd - 27th August) please select the service(s) that you would like to attend, or skip to the next question. Please note that Occupational Therapy and sensory integration is not available this week:

Physiotherapy

Conductive Education individual session

Conductive Education group session

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* 7. How many sessions would you like to book per week during the summer block?

1 - 4

5 - 9

10 – 14

Other (please specify)

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* 8. When are you available to attend sessions?

Morning

Afternoon

I’m flexible

CPotential Summer Intensive Block

Please complete the form to register your interest

Question Title

* 1. Please let us know the following information:

Question Title

* 2. Which week(s) are you interested in booking? Please select all applicable:

Question Title

* 3. If you selected that you would like to attend week one (2nd - 6th August) please select the service(s) that you would like to attend, or skip to the next question:

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* 4. If you selected that you would like to attend week two (9th - 13th August) please select the service(s) that you would like to attend, or skip to the next question:

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* 5. If you selected that you would like to attend week three (16th - 20th August) please select the service(s) that you would like to attend, or skip to the next question:

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* 6. If you selected that you would like to attend week four (23rd - 27th August) please select the service(s) that you would like to attend, or skip to the next question. Please note that Occupational Therapy and sensory integration is not available this week:

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* 7. How many sessions would you like to book per week during the summer block?

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* 8. When are you available to attend sessions?

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* 9. Please use this section to add any additional comments or questions