• Custom keyguard request form

  • Childs DOB*
     - -
    2 digit day, 2 digit month, 4 digit year
  • How is your childs NDIS plan managed*
  • Are you an existing NAPA client*
  •  -
  • Have you discussed or trialed a custom keyguard with one of your NAPA therapists?*
  • Keyguard Pricing: If delivery selected, Delivery fees apply*

  • Delivery information:

    Please note shipping costs will be included in your invoice for any keyguards not picked up from the Melbourne clinic. 
  • How will you receive your keyguard?*

  • Tablet and case information

  • If you are seeking a keyguard for a tablet other than an iPad, please reach out to melbourne@napacentre.com.au and we will be in touch to get more information. Note non-iPad keyguards are likely to incur a higher cost due to increased time required for custom fabrication.

  • Does the iPad have a case?*
  • What kind of case do you use? please refer to PDF here for options, and pick the best available option
  • Case Type*

  • Case dimensions

  • AAC app*

  • If you have selected other. there may be a higher cost. Someone will be in touch with further details before proceeding.

     

  • Browse Files
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  • Browse Files
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  • Orientation - when using the AAC app, is the camera located on the left or right side of the iPad?*
  • Image field 60
  • I understand by signing this JotForm, I authorise NAPA Centre to proceed with the production of your Keyguard and agree to cover all associated production and delivery costs*
  • Should be Empty: