Course Requested - Enhancing Therapy Outcomes with the Abilex Oral-Motor Exerciser
First Name
Last Name
Title
E-Mail 
Phone 
Facility or CompanyName
Facility Address 
Facility City  
State/Zip  /
   
Number and Type of
Facilities Involved
  Rehab Hostpital
 
  LTC
 
  Out Patient
 
  School
 
  Other
    
Number Therapists Invoved
in your Group interested
in attending?
  SLP/SLPA
 
  OT/COTA
 
  PT/PTA
 
  Other
   
Patient Population
  Adult
 
  Pediatric
 
  Both
 
Tell us what you have in mind.
e.g. What kind of course,
what disciplines
will be attending?, etc.