Filling The Gaps: Sensory Kit Intake Portal
Welcome to Filling The Gaps. As an RBT and Operations professional, I designed these kits to bridge the gap between clinic goals and home life. Please fill out the details below to reserve your custom sensory kit. If you have a discount code be sure to enter it at the bottom of this form. 
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What is your name? *
We have 4 different tiers of sensory boxes, please review the listings below this question and then respond here with the specific tier you are seeking to purchase. If you are wanting a personalized box option ALL questions  regarding your child's needs/preferences must be filled out on this form. Early Learner boxes are designed for developmental ages 2 - 7 and advanced learner boxes are designed for ages 7 + 

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Child's Age 
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Child's Developmental Level 
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Does your child have any sensory sensitivities?
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Please elaborate on your child’s sensory sensitivities. For ex. “He is afraid of loud noises”
What types of sensory activities does your child enjoy?
Does your child have any special interests or favorite characters?
Would you prefer a box that is 
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Anything else we should know to make your box extra special? 
How did you hear about us? *
I understand that personalized sensory boxes are customized based on the information provided and may contain small parts.  *
Did a specific creator or clinic refer you? 

Do you have a discount code? If yes please enter it below 
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