Home About Us Customer Reference G... CRG Expression of In... Customer Reference Group Expression of Interest Complete the form below to express your interest in joining our Customer Reference Group. First Name* Last Name* Phone Number* Email Address* What is your involvement with Therapy Focus?* Customer Parent/Guardian of customer Other (please specify) Other (please specify)*What services do you access at Therapy Focus (tick all that apply)?* Accommodation Assistive Technology / Home Modification Autism Assessment Continence Support Counselling / Psychology Dietetics Occupational Therapy Physiotherapy Positive Behaviour Support Psychology Specialist Disability Speech Pathology How did you find out about the Customer Reference Group and what is your interest in joining?*Declaration* I consent to act as a member of the Therapy Focus Customer Reference Group, and if I am appointed, declare that I not aware of any legal impediment (financial, personal or otherwise) that would deem me unfit for the position. NameThis field is for validation purposes and should be left unchanged.