Observation Request
Please fill out the form below to express your interest in observing one of our Speech, Physical, or Occupational Therapists.
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Current Education Level:
*
High School Student
Undergraduate College Student
Graduate Program Applicant
Other
What are you hoping to gain from this observation experience? (Choose all that apply)
*
Learn more about a potential career path
Fulfill a set number of observation hours required by my program
Work consistently with 1-2 therapists to gain a deeper understanding and potentially earn a letter of recommendation for program applications
Other
What disciplines are you interested in observing? (Choose all that apply)
*
PT
OT
ST
What population are you interested in observing? (Choose all that apply) *Please note that adult observation opportunities are limited and not guaranteed as we continue to build our caseload.
*
Primarily Pediatrics
Primarily Adults
A mix of both if available
Why are you interested in observing therapy at our clinic?
*
What types of diagnoses are you most interested in observing?
*
What are your career goals within the healthcare or therapy field?
*
How many hours are you hoping to observe?
*
By what date are you interested in completing your observation experience? Note: If we have availability, there may be a 2-week or more period between your application and placement date.
*
-
Month
-
Day
Year
Date
Preferred Observation Days & Schedule:
*
Do you have any questions or concerns you would like to discuss before starting your observation?
Submit
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