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Register for
Los Angeles – Fall Kickoff (waitlist only)

Sep 10 - Sep 28, 2018

Los Angeles – Fall Kickoff (waitlist only)

https://napacenter.org/events/los-angeles-fall-kickoff-2018/

  • Sep 10 - Sep 28, 2018
  • 11840 S La Cienega Blvd, Hawthorne, California 90250, USA

Registration Request

This form is a request to sign up for an intensive session. Your session will not be confirmed until you receive an email with a tentative schedule and place a deposit for the session booking.

Intake forms

Not sure what therapies you should be requesting for? Before filling out our registration form, you must first fill out the intake paperwork below. Once you do, our team of therapists will determine what type of therapies and how many hours are appropriate for an intensive session.

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Apply for this session.

    Patient Information

    Patient Name*
    Parent / Guardian Name*
    Phone Number
    Email*
    Patient Intake Paperwork Completed?*

    Session Information

    Session Duration*
    Would you like a break in the session?*
    Break Length*
    Type of Therapy*

    Session Preferences

    Which preference is most important to you?*
    Which start times will work for you?*

    We do our best to match your child with therapists they've worked with in the past but this is not guaranteed. If you're flexible or unsure on your child's therapy team, leave the section below blank and we will do our best to match your child with who we think they will work with best.

    Therapist 1
    Therapist 2
    Therapist 3
    Therapist 4
    Would you like to stay at the NAPA apartment?*
    Additional Requests

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