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Ability Plus Therapy Inc. 4450 W. EauGallie Blvd. suite 180
Melbourne, Florida 32934
phone - 321-255-6627 / fax - 321-253-9777

Copyright © 2009. All rights reserved.
Contact Information Form

First Name Last Name Address City State Zip Code
Country Home Phone
Email Child's Name Child's Age or Birthdate
Child's Diagnosis

Please provide a brief description of why you would believe your Child would benefit from intensive physical therapy.


Please Complete the Entire Contact Information Form
and Submit for a Chance to Win the
Free Intensive Therapy Session for 2014
This form is for Parents of Children with Disabilities to apply for a chance to Win a Specialized 3 week Intensive Therapy Session tailored to fit the needs of their Child for the most positive results.
If you are a business attempting to contact us, please do so by using the email or phone numbers provided on our contact page. Thank you for not soliciting us on this form.