Initial Availability for Therapy

Initial Availability for Therapy

Please note- the more open your schedule, the higher likelihood that we schedule you to the fullest extent of your authorization/desired schedule. We require that, unless approved by our clinical team in advance, your availability allows us to schedule a minimum of 80% of your authorized hours. Moreover, 80% of the availability that you provide must be between Monday-Friday. For each day of availability, there must be a minimum of 2 consecutive hours of availability. Please contact us via phone or text at (510) 910-4449 with questions or concerns.
Client's Name: *

First Name Last Name
A responsible adult must be present for all sessions. Please let the names of all responsible adults who may be present during and sign for all sessions.
Where will the sessions take place? (Please complete a new form for each location) *

Home School
If "Other" is chosen above, please note the type of location
Session Address:
Preferred Session Time

Please enter the time you are available for sessions. If you are unavailable, please check the box instead
On Sunday, our family is available for a session between the hours ofblanks andblank.
Our family is NOT AVAILABLE for sessions on Sunday
On Monday, our family is available for a session between the hours of blanks andblank.
Our family is NOT AVAILABLE for sessions on Monday
On Tuesday, our family is available for a session between the hours ofblanks andblank.
Our family is NOT AVAILABLE for sessions on Tuesday
On Wednesday, our family is available for a session between the hours ofblanks andblank.
Our family is NOT AVAILABLE for sessions on Wednesday
On Thursday, our family is available for a session between the hours ofblanks andblank.
Our family is NOT AVAILABLE for sessions on Thursday
On Friday, our family is available for a session between the hours ofblanks andblank.
On Saturday, our family is available for a session between the hours ofblanks andblank.
Our family is NOT AVAILABLE for sessions on Friday
Our family is NOT AVAILABLE for sessions on Saturday
If your property requires a code for entry, please provide it here: Type a label
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Initial Availability for Therapy

Preferred Session Time