Children's Assistive Technology Service
Comm. Loan Library
Unicorn Switch toy with big red switch
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Unicorn Switch toy with big red switch

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SKU:
10101108474177
Items available:
0

Walking unicorn toy- walks and wags his tail with big red switch

Communication Loan Library:
¥ Items available only ON LOAN for 3 months
¥ Must be recommended by the childÕs Speech Therapist Ð please put speech therapist contact information in the ÒnotesÓ section of the item request form
¥ These items are available only to Hampton Roads surrounding area residents

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Our Sponsors

C.A.T.S. provides for the re-use of pediatric rehabilitation equipment and assistive technology devices in Virginia. We serve as a no-cost resource for children with disabilities who need adaptive equipment and whose families have limited resources.

EIN

a 501(c)3 public charity
EIN: 46-4866068

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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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Therapist Email

Child Info

Child Name
Race
Age
Height
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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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Please Note:

The fields above are required to complete your equipment request. We also require a signed Equipment Release Form to process your request. Please sign the Equipment Release Form at the button below.

Required Equipment Release Form
Liberación de Equipo

Equipment Release

Please Read and Sign before submitting your request.

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