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we’re so happy you’re here!

Please fill out the form below to provide us with some information on what service(s) you may be interested in, along with what priorities or goals you might have.

Please note that filling out this information does not obligate you in anyway to receive services. Per our privacy policy, your information is confidential and important to us, and will not be abused or shared.

First Name

Phone

Last Name

What is your preferred method of contact?

Phone Call

Text

What is the age of the individual you are seeking services for?

What is your relationship to this individual? (Parent, grandparent, guardian, etc.)

What type of service(s) are you interested in?

1-on-1 Occupational Therapy

OT Groups

Caregiver Coaching

One-Time Consultation

* Please note that caregiver coaching sessions and one-time consultations are not a substitute for skilled occupational therapy services. *

Select all that apply to this individual

Currently receiving OT services

Has received OT services in the past

Has had an OT evaluation completed within the past 12 months

Has never received OT services

Please use the space below to provide any additional information that may be helpful when determining appropriate services.

Thanks for submitting!

occupational therapy + consultation interest form

859-545-1620

admin@developmentools.net

lexington, kentucky + nashville, tennessee

The information on this site is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images and information, contained on or available through this website is for general information purposes only. Never disregard professional medical advice or delay seeking medical treatment because of something you have read or accessed through this website. By utilizing this site, you acknowledge that Developmentools does not recommend, endorse or make any representation about the efficacy, appropriateness or suitability of any specific tests, products, procedures, treatments, services, opinions, health care providers or other information that may be contained on or available through this website. Please consult your child’s doctor, therapist or healthcare professional with any questions.

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