Scheduling Large or Permanent Changes
Please answer all questions - even if you feel I already have the information... it's just SO helpful in finding a way to give you what you need. Thank you.

Note: This form is for changes to your schedule that are permanent changes or changes larger than three changes within a month.

Email address
Parent Name
Your answer
Student Name
Your answer
Primary Clinician (or describe if you would prefer a change in clinician)
Your answer
What is the part of your current schedule that you do NOT want to change?
Your answer
What part of your current schedule would you LIKE to change? Describe the ideal option. (Example: Currently my son is coming from 3-5:30 on Wednesdays. We prefer to keep the same time on a different day. The best option would be 3-5:30 on Thursdays instead)
Your answer
If you preferred time/day is not possible, are you willing to change clinicians?
If your preferred time is not possible, what are some other options?
Your answer
Please state the times that are absolutely NOT possible:
Your answer
How well is TLC meeting your expectations?
I'm disappointed
Fabulously well
How well are you satisfied with your child's growth so far?
I'm disappointed
I'm thrilled!
How well are you satisfied with the communication you are receiving from your clinician?
I'm disappointed
I'm thrilled!
Please provide any other information that we might need to best meet your expectations for the care of your child. (This could be scheduling or anything else!)
Your answer
THANK YOU!
If you have any further questions, comments or needs regarding scheduling, please email scheduling@therapeuticliteracycenter.com

If you have any other comments - positive or with concerns - please email me directly at maria@therapeuticliteracycenter.com or call me directly on my cell at (858) 668-8366 voice/text.

A copy of your responses will be emailed to the address you provided.
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