{"id":1659,"date":"2024-02-03T22:15:09","date_gmt":"2024-02-03T22:15:09","guid":{"rendered":"https:\/\/newheightspediatrictherapy.com\/?page_id=1659"},"modified":"2025-08-15T03:23:58","modified_gmt":"2025-08-15T02:23:58","slug":"observation-request-form","status":"publish","type":"page","link":"https:\/\/newheightspediatrictherapy.com\/index.php\/observation-request-form\/","title":{"rendered":"Observation Request form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"1659\" class=\"elementor elementor-1659\">\n\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-19c7efd e-flex e-con-boxed e-con e-parent\" data-id=\"19c7efd\" data-element_type=\"container\" data-settings=\"{&quot;content_width&quot;:&quot;boxed&quot;}\" data-core-v316-plus=\"true\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-3982ede elementor-widget elementor-widget-heading\" data-id=\"3982ede\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.16.0 - 20-09-2023 *\/\n.elementor-heading-title{padding:0;margin:0;line-height:1}.elementor-widget-heading .elementor-heading-title[class*=elementor-size-]>a{color:inherit;font-size:inherit;line-height:inherit}.elementor-widget-heading .elementor-heading-title.elementor-size-small{font-size:15px}.elementor-widget-heading .elementor-heading-title.elementor-size-medium{font-size:19px}.elementor-widget-heading .elementor-heading-title.elementor-size-large{font-size:29px}.elementor-widget-heading .elementor-heading-title.elementor-size-xl{font-size:39px}.elementor-widget-heading .elementor-heading-title.elementor-size-xxl{font-size:59px}<\/style><h2 class=\"elementor-heading-title elementor-size-default\">Observation Request Form<\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-d419f6f elementor-widget__width-initial elementor-widget elementor-widget-wpforms\" data-id=\"d419f6f\" data-element_type=\"widget\" data-widget_type=\"wpforms.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style id=\"wpforms-css-vars-root\">\n\t\t\t\t:root {\n\t\t\t\t\t--wpforms-field-border-radius: 3px;\n--wpforms-field-background-color: #ffffff;\n--wpforms-field-border-color: rgba( 0, 0, 0, 0.25 );\n--wpforms-field-text-color: rgba( 0, 0, 0, 0.7 );\n--wpforms-label-color: rgba( 0, 0, 0, 0.85 );\n--wpforms-label-sublabel-color: rgba( 0, 0, 0, 0.55 );\n--wpforms-label-error-color: #d63637;\n--wpforms-button-border-radius: 3px;\n--wpforms-button-background-color: #066aab;\n--wpforms-button-text-color: #ffffff;\n--wpforms-field-size-input-height: 43px;\n--wpforms-field-size-input-spacing: 15px;\n--wpforms-field-size-font-size: 16px;\n--wpforms-field-size-line-height: 19px;\n--wpforms-field-size-padding-h: 14px;\n--wpforms-field-size-checkbox-size: 16px;\n--wpforms-field-size-sublabel-spacing: 5px;\n--wpforms-field-size-icon-size: 1;\n--wpforms-label-size-font-size: 16px;\n--wpforms-label-size-line-height: 19px;\n--wpforms-label-size-sublabel-font-size: 14px;\n--wpforms-label-size-sublabel-line-height: 17px;\n--wpforms-button-size-font-size: 17px;\n--wpforms-button-size-height: 41px;\n--wpforms-button-size-padding-h: 15px;\n--wpforms-button-size-margin-top: 10px;\n\n\t\t\t\t}\n\t\t\t<\/style><style id=\"wpforms-css-vars-elementor-widget-d419f6f\">\n\t\t\t\t.elementor-widget-wpforms.elementor-element-d419f6f {\n\t\t\t\t\t--wpforms-field-size-input-height: 43px;\n--wpforms-field-size-input-spacing: 15px;\n--wpforms-field-size-font-size: 16px;\n--wpforms-field-size-line-height: 19px;\n--wpforms-field-size-padding-h: 14px;\n--wpforms-field-size-checkbox-size: 16px;\n--wpforms-field-size-sublabel-spacing: 5px;\n--wpforms-field-size-icon-size: 1;\n--wpforms-label-size-font-size: 16px;\n--wpforms-label-size-line-height: 19px;\n--wpforms-label-size-sublabel-font-size: 14px;\n--wpforms-label-size-sublabel-line-height: 17px;\n--wpforms-button-size-font-size: 17px;\n--wpforms-button-size-height: 41px;\n--wpforms-button-size-padding-h: 15px;\n--wpforms-button-size-margin-top: 10px;\n\n\t\t\t\t}\n\t\t\t<\/style><div class=\"wpforms-container wpforms-container-full wpforms-render-modern\" id=\"wpforms-1661\"><form id=\"wpforms-form-1661\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"1661\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/index.php\/wp-json\/wp\/v2\/pages\/1659\" data-token=\"5bc196f41ab6b3d17f307e12556f2758\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-hidden\" id=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-1661-field_0-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"0\"><fieldset><legend class=\"wpforms-field-label\">Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-1661-field_0\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][0][first]\" aria-errormessage=\"wpforms-1661-field_0-error\" required><label for=\"wpforms-1661-field_0\" class=\"wpforms-field-sublabel after \">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-1661-field_0-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][0][last]\" aria-errormessage=\"wpforms-1661-field_0-last-error\" required><label for=\"wpforms-1661-field_0-last\" class=\"wpforms-field-sublabel after \">Last<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-1661-field_3-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-1661-field_3\">Phone Number <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-1661-field_3\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][3]\" aria-errormessage=\"wpforms-1661-field_3-error\" aria-describedby=\"wpforms-1661-field_3-description\" required><div id=\"wpforms-1661-field_3-description\" class=\"wpforms-field-description\">(Please use numbers only. Thanks!)<\/div><\/div><div id=\"wpforms-1661-field_1-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"1\"><label class=\"wpforms-field-label\" for=\"wpforms-1661-field_1\">Email <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-1661-field_1\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][1]\" spellcheck=\"false\" aria-errormessage=\"wpforms-1661-field_1-error\" required><\/div><div id=\"wpforms-1661-field_5-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"5\"><fieldset><legend class=\"wpforms-field-label\">Please select your role: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1661-field_5\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1661-field_5_1\" name=\"wpforms[fields][5]\" value=\"High School Student\" aria-errormessage=\"wpforms-1661-field_5_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1661-field_5_1\">High School Student<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1661-field_5_2\" name=\"wpforms[fields][5]\" value=\"Undergraduate Student\" aria-errormessage=\"wpforms-1661-field_5_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1661-field_5_2\">Undergraduate Student<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-1661-field_5_3\" name=\"wpforms[fields][5]\" value=\"Graduate Student\" aria-errormessage=\"wpforms-1661-field_5_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1661-field_5_3\">Graduate Student<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-1661-field_5_4\" name=\"wpforms[fields][5]\" value=\"None of the above\" aria-errormessage=\"wpforms-1661-field_5_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1661-field_5_4\">None of the above<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1661-field_6-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"6\"><fieldset><legend class=\"wpforms-field-label\">What services are you interested in observing?: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1661-field_6\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1661-field_6_1\" name=\"wpforms[fields][6][]\" value=\"Occupational Therapy\" aria-errormessage=\"wpforms-1661-field_6_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1661-field_6_1\">Occupational Therapy<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-1661-field_6_2\" name=\"wpforms[fields][6][]\" value=\"Speech Therapy\" aria-errormessage=\"wpforms-1661-field_6_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1661-field_6_2\">Speech Therapy<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-1661-field_6_3\" name=\"wpforms[fields][6][]\" value=\"Lactation Services\" aria-errormessage=\"wpforms-1661-field_6_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1661-field_6_3\">Lactation Services<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1661-field_7-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"7\"><fieldset><legend class=\"wpforms-field-label\">How many hours would you like to observe? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1661-field_7\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1661-field_7_1\" name=\"wpforms[fields][7]\" value=\"0-10\" aria-errormessage=\"wpforms-1661-field_7_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1661-field_7_1\">0-10<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1661-field_7_2\" name=\"wpforms[fields][7]\" value=\"11-20\" aria-errormessage=\"wpforms-1661-field_7_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1661-field_7_2\">11-20<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-1661-field_7_3\" name=\"wpforms[fields][7]\" value=\"21-50\" aria-errormessage=\"wpforms-1661-field_7_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1661-field_7_3\">21-50<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-1661-field_7_4\" name=\"wpforms[fields][7]\" value=\"51-100\" aria-errormessage=\"wpforms-1661-field_7_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1661-field_7_4\">51-100<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1661-field_9-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"9\"><label class=\"wpforms-field-label\" for=\"wpforms-1661-field_9\">When would you like to complete observation hours? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1661-field_9\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][9]\" aria-errormessage=\"wpforms-1661-field_9-error\" aria-describedby=\"wpforms-1661-field_9-description\" required><div id=\"wpforms-1661-field_9-description\" class=\"wpforms-field-description\">Please provide the season & year (i.e. Fall 2025) or specific date range (i.e. 5\/1\/25-7\/31\/25).<\/div><\/div><div id=\"wpforms-1661-field_11-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"11\"><fieldset><legend class=\"wpforms-field-label\">Are you interested in learning about our internship opportunities? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-1661-field_11\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-1661-field_11_1\" name=\"wpforms[fields][11]\" value=\"Yes, please!\" aria-errormessage=\"wpforms-1661-field_11_1-error\" aria-describedby=\"wpforms-1661-field_11-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1661-field_11_1\">Yes, please!<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-1661-field_11_2\" name=\"wpforms[fields][11]\" value=\"No, thank you.\" aria-errormessage=\"wpforms-1661-field_11_2-error\" aria-describedby=\"wpforms-1661-field_11-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1661-field_11_2\">No, thank you.<\/label><\/li><\/ul><div id=\"wpforms-1661-field_11-description\" class=\"wpforms-field-description\">*If interested, please email your resume to info@newheightspediatrictherapy.com<\/div><\/fieldset><\/div><div id=\"wpforms-1661-field_2-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-1661-field_2\">Please tell us a little bit about yourself:<\/label><textarea id=\"wpforms-1661-field_2\" class=\"wpforms-field-medium\" name=\"wpforms[fields][2]\" aria-errormessage=\"wpforms-1661-field_2-error\" ><\/textarea><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"1661\"><input type=\"hidden\" name=\"wpforms[author]\" value=\"1\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-1661\" class=\"wpforms-submit\" data-alt-text=\"Sending\u2026\" data-submit-text=\"Submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/newheightspediatrictherapy.com\/wp-content\/plugins\/wpforms-lite\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container -->\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Observation Request Form Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. Name * FirstLast Phone Number *PLEASE USE THIS FORMAT: (XXX) XXX-XXXXEmail * Please select your role: * High School Student Undergraduate Student Graduate Student None of the above What services are you interested&hellip;&nbsp;<a href=\"https:\/\/newheightspediatrictherapy.com\/index.php\/observation-request-form\/\" class=\"\" rel=\"bookmark\">Read More &raquo;<span class=\"screen-reader-text\">Observation Request form<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"page-templates\/template-pagebuilder-full-width.php","meta":{"om_disable_all_campaigns":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"","neve_meta_content_width":0,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","_themeisle_gutenberg_block_has_review":false,"_ti_tpc_template_sync":false,"_ti_tpc_template_id":"","footnotes":""},"class_list":["post-1659","page","type-page","status-publish","hentry"],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/newheightspediatrictherapy.com\/index.php\/wp-json\/wp\/v2\/pages\/1659","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/newheightspediatrictherapy.com\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/newheightspediatrictherapy.com\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/newheightspediatrictherapy.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/newheightspediatrictherapy.com\/index.php\/wp-json\/wp\/v2\/comments?post=1659"}],"version-history":[{"count":8,"href":"https:\/\/newheightspediatrictherapy.com\/index.php\/wp-json\/wp\/v2\/pages\/1659\/revisions"}],"predecessor-version":[{"id":2087,"href":"https:\/\/newheightspediatrictherapy.com\/index.php\/wp-json\/wp\/v2\/pages\/1659\/revisions\/2087"}],"wp:attachment":[{"href":"https:\/\/newheightspediatrictherapy.com\/index.php\/wp-json\/wp\/v2\/media?parent=1659"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}