Medical and Dental Training Request Form - Delaware Network for Excellence in Autism

Medical providers and offices are encouraged to contact the DNEA for additional training on using visual supports – including Communicating Visually in Pediatrics – and other evidence-based practices in medical settings. Use this form to request a DNEA training or a free copy of Communicating Visually in Pediatrics.

Practice/Business Name(Required)

Person Completing the Form(Required)

Type of Medical Practice(Required)

Description of Medical Practice(Required)

County(ies)(Required)

Kent

New Castle

Sussex

Address(Required)

Street Address Address Line 2 City ZIP Code

Contact Email(Required)

Enter Email Confirm Email

Business Website

Contact Phone

Number of Copies Requested

If requesting multiple copies, a representative from DNEA will contact you to confirm the availability of copies before shipping.

The DNEA offers in-person and virtual training and technical assistance to support best practices when using visual supports. Are you interested in receiving office/provider free training or technical support?(Required)

Yes

This field is for validation purposes and should be left unchanged.