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Full Name
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Discipline (Check all that apply):
Occupational Therapist (OT)
Speech-Language Pathologist (SLP)
Physical Therapist (PT)
ABA Therapist / BCBA
Mental Health Counselor (LMHC, LCSW, etc.)
Do you have experience working with neurodivergent children?
Yes
No
Are you available for onsite sessions at Our Corner (Clearwater location)?
Yes
No
Possibly / Open to discussing
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Tell us why you’re interested in working with Our Corner:
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How Did You Hear About Us?
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Friend/Family
School
We Rock the Spectrum
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Therapist Application Form
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