Request for Observation

Thank you for your interest in The Therapy Place. We are currently not accepting students or observers for the Spring 2017 semester. If you are interested in Summer 2017 or beyond please fill out the form below for consideration. Thank you again for your interest!

Your Name:
Today’s Date (MM/DD/YYYY):
Your Email:

Your Phone:

Preferred Specialty

Physical Therapy:  Occupational Therapy:   Speech Therapy:  Special Education Pre-School

Total observation hours needed:

Time frame to complete hours (Start date, End date):

Dates and times of day that you are available:

Reason for hours