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Email
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Your email
Full Name
(Caregiver or Participant)
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Referred By:
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Phone Number:
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Name of Participant
(if different from above)
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Age of Participant:
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Are you signing up as:
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A neurodivergent individual
A parent or caregiver on behalf of a neurodivergent individual
Preferred Therapy Sessions
(select up to 2)
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Occupational Therapy
Educational Therapy
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Additional comments or questions
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Consent Agreement
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I confirm that the participant is aged 5 or above. I agree to download both Apps from
https://theratech.ai/app-store/
and
complete the trial of Smartie and Smartie Care and submit both pre- and post-trial surveys. I understand that the 2 free therapy sessions are for the neurodivergent participant and must be used within a specified timeframe. I consent to survey data being shared with SG Enable. I acknowledge that Dynamics Therapy Group and its affiliates may change the terms of this promotion at any time without notice.
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