TFH Sensory Room Information Form

Let Us Help You Create A Sensory Room

Please complete this form and one of our sensory room consultants will be in touch with you to discuss your project. Our Design Consultation Service is FREE and we will provide you with a computerized design and quote. We work with you until you are happy.
Name

First NameLast Name
Title
Administrator, Director, Teacher, Therapist, Caregiver, Parent, etc.
Facility Type
School, Clinic, Service Organization, Hospital, Medical, Home, Other
Facility Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail*
example@example.com
Phone Number*

Area CodePhone Number
Best Time To Call
Include Time Zone
Sensory Room Needs
Goal for Sensory Room

CalmingFocus/ConcentrationStimulationSocializationDe-EscalationActive/Sensory Gym
Tell Us More...
We want this equipment...

Bubble or Hurricane TubesFiber OpticsProjectorSeatingVibroacousticTactile FeaturesMobile Sensory OptionsVestibular FeaturesAuditory FeaturesCause and Effect FeaturesOther
Equipment We Don't Want
Sensory Room Training

YesNo
Sensory Room Installation

YesNo
Age Range
How many people will this room serve?
How many Sensory Rooms & where will they be located?
Diagnosis
List all that apply now and in the future.
Non-Ambulatory
Just an estimated percentage
Type of Guidance Needed
Budget
Funding Source

Grant ReceivedGrant ProposalFunding SecuredESSER FundingNeed Funding ResourcesOther
Anticipated Order Date
Physical Aspects of Room(s)
Wall Type (check all that apply)

Drywall/Sheet RockCement BlockPlasterOther
Wall Stud Type (check all that apply)

WoodMetalOther
Type of Ceiling

Tiles (Drop Ceiling)Drywall or SolidOther
Height of Ceiling
Sketch of Room

A hand-drawn sketch of the room is essential to make sure the equipment fits your space.

Please include the following:
- Room Dimensions (each wall)
- Door Dimensions and Placement in Room
- Window Dimensions and Placement in Room
- Outlets (mark with X on the drawing)
- All permanent structures in the room (closets, bathrooms, electrical raceways, sinks, etc.)
Upload sketch here.

Cancelof
Upload photos here.

Cancelof
Should be Empty:

Let Us Help You Create A Sensory Room

Sensory Room Needs

Physical Aspects of Room(s)