Therapy Fund Interest Form

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The Loveland Therapy Fund sign up has reached capacity for the quarter. Leave your email below and we'll let you know when we're accepting signups again for the next cohort.

IMPORTANT: If you are a current Therapy Fund recipient seeking additional vouchers please do not fill out this form. Instead, please email your request to info@thelovelandfoundation.org. Thank you.

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Full Name *

Your answer

Email Address *

Your answer

I am completing this form for:
*

Myself

A loved one over the age of 18

A loved one under the age of 18

My client

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