Register for Rapid Toilet Training!

**PLEASE NOTE: This is a private, 1:1 training opportunity.

Therefore, only 1 child and their caregiver will be receiving service in our offices during their desired time slot. This means we will be reserving time slots for participants on a first come, first serve basis in the case of multiple requests for the same date or time slot. Registering for Consultation and/or the Focused Package does not reserve your spot until payment is received. After you submit your registration, we will reach out to you directly to confirm your selected dates and times and to discuss payment. Following confirmation of your selected dates and times, we will hold the discussed dates and times for 48 hours, until payment is received.**

Registration Deadline for ALL January Sessions is December 27, 2024
Registration Deadline for ALL February Sessions is January 17, 2025

For Which Service Are You Registering?

Virtual Consultation ONLY

Virtual Consultation + Focused Package

Child's Name

First Name

Last Name

Participating Caregiver Name

Please provide the name of the caregiver who will be receiving training

First Name

Last Name

Phone

(###)

###

####

Child's Date of Birth

YYYY

Gender Identity

Male

Female

Non-Binary

Other

Prefer Not to Say

Diagnosis (if any)

For example, ADHD. If none, please write "none"

Most Preferred Date and Times

Alternate Preferred Date and Times

Last-Choice Date and Times