Please review the information below. If everything is correct, click “Send”. To go back and edit your entries, click “Edit”.
The following required items were not provided or are in the wrong format. Please provide the required responses and submit again:
Contact person's first and last name
First and last name of person who will be receiving services
Child (under age 18) Adult (age 18 and older)
Contact person's relationship to person who will be receiving services (ex: mother, grandparent, sibling)
Contact person's email address
Contact person's phone number
Type of therapy needed (physical, occupational, speech, massage, aquatic)
Best days and times for appointments (ex: Monday or Tuesday afternoons)
Other information to help our therapy team
How did you hear about us? (Google search, Facebook, family or friend, Curative website, radio advertisement, etc)
Before therapy services may begin, all necessary paperwork will need to be completed and signed by the individual’s legal guardian.