Observation Request Form

Thank you for your interest in occupational therapy! We are excited to be able to share some of our experiences with you. Please complete the form below in its entirety to be considered for observation hours.

At the bottom of the form is a place to upload your current immunization records. All immunizations must be up-to-date, and show that you have received a flu shot and had a TB test within the past year.

Upon receipt of the form and your immunization documentation, we will follow-up with you to schedule a HIPAA training session, which must be completed prior to your observation experience. We will then match you with an appropriate provider in our Community Practice who will contact you to schedule your session.