Making IT Accessible to ALL
Email*:
Parent / Guadian First Name*:
Parent / Guadian Last Name*:
Time Slots*:9:00 AM - 10:00 AM10:00 AM - 11:00 AM11:00 AM - 12:00 PM (Noon)12:00 PM (Noon) - 1:00 PM1:00 PM - 2:00 PM2:00 PM - 3:00 PM3:00 PM - 4:00 PM4:00 PM - 5:00 PM5:00 PM - 6:00 PM6:00 PM - 7:00 PM
Age of Participant*:
Age In*:in monthsin years
Daytime Phone Number*:
City*:
State*:AL AlabamaAK AlaskaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFL FloridaGA GeorgiaHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaOH OhioOK OklahomaOR OregonPA PennsylvaniaRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming
30-minute online video consultation
regularly scheduled teletherapy
Other
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