Barrett Family Wellness Center Fall Schedule Form
Thank you for your time today in helping to schedule your Fall appointments. This survey should take approximately 5 minutes to complete. Progress on the form cannot be saved and, therefore, it must be completed in one sitting. Please give us a call at 508-898-2688 if you have any questions.

If you have more than one child that receives services at Barrett, this form must be completed separately for each child. When you complete the form for the first child there will be an option with a link to complete it again for an additional child/children.

It is strongly advised that you fill out this form on a computer using the most recent version of any of the following browsers: Chrome, Firefox, Safari (for Mac), and Internet Explorer. For mobile devices, you must be using the most recent versions of the Android or iOS operating system. You will know the form has been submitted and received through receipt of an automated confirmation email. If you do not receive an email, you can assume we most likely did not receive it and will need to have it resubmitted.

This form MUST be completed by Sunday, July 23rd in order for your preferences to be observed. Any requests that are received after that date will be scheduled into remaining open slots and not based on preferences.

Please do not use your back button on the browser. If you need to go to a previous page on the form, please do so by using the navigation buttons within the form. You are able to edit your response after the form has been submitted.

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