child with assistive technology in a field
Want to contact us?

Please see below for the contact information of our four locations!

Hampton Roads & Roanoke

ATN: Linda Dew
900 Granby Street, Suite 138
Norfolk, VA 23510

hr@atdevicesforkids.org(757) 763-8905

ATN: Maggie Forbes
5568 Airport Road
Roanoke, VA 24012

roa@atdevicesforkids.org(540) 493-2285

Richmond &
Northern Virginia

ATN: Monica Beach
2545 Gayton Centre Dr.
Richmond VA 23238

rva@atdevicesforkids.org(540) 420-0554

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The below information is required for our record keeping and equipment fitting purposes.

Parent/Guardian Info

Parent/Guardian Name
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Therapist Info

Therapist Name
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Child Info

Child Name
Race
Age
Height
Weight

Other Info

Why did you choose to obtain an AT device/service from our program?
What type of insurance does the child have?
Has the requested equipment been denied by Insurance?
Persons in Household
Family Income Range
Is this child currently a client of the Department of Aging and Rehabilitative Services (DARS)?
Diagnosis
The primary reason for which the child and family needs an AT device or service is related to:
Will equipment be used at home, school or both?
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Equipment Release

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