Physical Therapy Virtual Information Session

Email Address

First Name

Middle Name

Last Name

Birthdate

May we send you text reminders?

Yes

No

Cell Phone Number

Expected Start Date

Do you require any accomodations in order to view this webinar?

Yes

No

Which accomodations are you requesting?

Digital copies of materials in advance

Live, realtime captioning (CART captioning)

ASL interpreters

Other

Other:

Hidden Program = Physical Therapy

Hidden Event Tracking = Physical Therapy Information Session