Therapeutic Options Interest List

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please let us know what you are looking for! Thank you!

Name *

Agency *

Agency location (city, state) *

Email address *

Phone number *

I want to

Recertify myself or a staff member

Certify myself or a staff member

Recertify a group from my agency (please list number below)

Certify a group from my agency (please list number below)

Other:

I am interested in hosting a Therapeutic Options recertification or certification session. *

The Therapeutic Options recertification (for up to 18 people) is a one day session. The certification is held over 4 days and for up to 16 people. Sessions run from 8:30 am – 4 pm with a one-hour break for lunch. The start and end times can be adjusted 30 minutes if needed by the hosting agency/site.

We offer a $100/room credit for hosting and a priority registration for agency staff before the session is open to the public.

Yes

Maybe, but I need more information

Any questions or something you'd like us to know?

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Forms