Share your Fall Plans Please take a few minutes to let us know about your fall plans! We’ll use this information to ensure continuity of services this fall. Your Name First Last Child's Name First Last Services your child receives ABA Feeding and swallowing OT PT Counseling Speech Fall Therapy ScheduleDoes your child currently have a recurring appointment(s)?YesNoOn what day(s)/time(s)Would you like to keep this time for the Fall?YesNoWhat days and times would work best?What date would you like this new schedule to start? Date Format: MM slash DD slash YYYY *Please note that we will make our best effort to accommodate your availability and appreciate your flexibility should we need to suggest alternate times and days. This iframe contains the logic required to handle Ajax powered Gravity Forms.