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AZ+A Occupational Therapy Telehealth
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* Indicates required question
Email
*
Your email
Parent's Name
*
Your answer
Names and Ages of Children
*
Your answer
Phone
*
Your answer
If your child is a current client, who (which therapist) does your child see?
Your answer
Occupational Therapy: I am interested in the following virtual home sessions (check all that apply)
*
Individual Sessions
Group Sessions
Parent Sessions
Family Sessions
Required
What is your preferred time and length of time for VIRTUAL home sessions to be scheduled? (check all that apply)
*
Less than an hour
1-2 hours
2+ hours
Mornings
Afternoons
Early evenings (before 7p.m.)
Required
On which day(s) would you be interested in weekly VIRTUAL home therapy sessions? (check all that apply)
*
Mondays
Tuesdays
Wednesdays
Thursdays
Fridays
Saturdays
Required
Please tell us about any other requests so we can do our best to suit your family's needs.
*
Your answer
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