Let’s work together.Please fill out this form or call (309)300-8737 if you are interested in scheduling an appointment Name: * First Name Last Name Patient's name: First Name Last Name Email: * Phone: * (###) ### #### What service are you interested in? Occupational Therapy Developmental Services Functional Neurological Disorder (FND) Services Days of the week that work best: * Monday Tuesday Wednesday Thursday Friday Saturday Sunday Best time of day for appointments: Morning (9:00 am -12:00 pm CST) Afternoon (12:00 pm -4:00 pm CST) Evening (4:00 pm - 7:00 pm CST) Appointment Location: * Virtual In-person Please briefly tell us why you are seeking services. * We will send you an intake form after we have scheduled your appointment that will ask for more detailed information on what you are seeking from your therapy/service experience. Would you prefer a phone call or email to finish scheduling the initial appointment? * Email Phone call Thank you! We can’t wait to get started! We will reach out over the next 48 hrs to finish scheduling our initial appointment together.