{"id":13090,"date":"2026-09-27T06:43:00","date_gmt":"2026-09-27T06:43:00","guid":{"rendered":"https:\/\/www.therapcanada.ca\/products\/?page_id=13090"},"modified":"2026-10-14T08:03:49","modified_gmt":"2026-10-14T08:03:49","slug":"employment-services","status":"publish","type":"page","link":"https:\/\/www.therapcanada.ca\/products\/employment-services\/","title":{"rendered":"Employment Services Software for Social Services | Therap Canada"},"content":{"rendered":"<div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1 fusion-flex-container has-pattern-background has-mask-background nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"max-width:1420.64px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-0 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:20px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><!-- Main content landmark -->\n<main id=\"emp-main\" role=\"main\" aria-labelledby=\"emp-main-heading\">\n  <div\n    class=\"llm-context\"\n    aria-hidden=\"true\"\n    style=\"\n      position: absolute;\n      width: 1px;\n      height: 1px;\n      padding: 0;\n      margin: -1px;\n      overflow: hidden;\n      clip: rect(0, 0, 0, 0);\n      white-space: nowrap;\n      border: 0;\n    \"\n  >\n    Therap Canada's Employment Services suite streamlines supported employment\n    and vocational tracking for disability service providers. By capturing\n    mobile, point-of-service documentation for job coaching, career discovery,\n    milestones, and wage metrics, Therap Canada helps drive compliance and\n    outcome reporting for provincial funders.\n  <\/div>\n  <!-- ===== Hero Section ===== -->\n  <section class=\"hero\" aria-labelledby=\"emp-main-heading\">\n    <div class=\"hero-container\">\n      <div class=\"hero-content\">\n        <h1 id=\"emp-main-heading\" class=\"hero-section-heading\">\n          Employment Services Tools for Disability Providers\n        <\/h1>\n        <h2 class=\"subheading\">\n          Track Career Discovery, Job Coaching, Workplace Success and\u00a0more.\n        <\/h2>\n\n        <button id=\"open-contact-modal\" class=\"btn-primary\" type=\"button\">\n          Contact Us\n          <svg\n            xmlns=\"http:\/\/www.w3.org\/2000\/svg\"\n            viewBox=\"0 0 640 640\"\n            aria-hidden=\"true\"\n            focusable=\"false\"\n          >\n            <path\n              d=\"M566.6 342.6C579.1 330.1 579.1 309.8 566.6 297.3L406.6 137.3C394.1 124.8 373.8 124.8 361.3 137.3C348.8 149.8 348.8 170.1 361.3 182.6L466.7 288L96 288C78.3 288 64 302.3 64 320C64 337.7 78.3 352 96 352L466.7 352L361.3 457.4C348.8 469.9 348.8 490.2 361.3 502.7C373.8 515.2 394.1 515.2 406.6 502.7L566.6 342.7z\"\n            ><\/path>\n          <\/svg>\n        <\/button>\n\n        <p class=\"hero-desc\">\n          Therap Canada's Employment Services module centralizes the employment\n          lifecycle. By bridging the gap between career planning and daily\n          documentation, we give your team the tools to focus less on paperwork\n          and more on promoting independence for the individuals you support.\n        <\/p>\n      <\/div>\n\n      <!-- Hero image -->\n      <div class=\"hero-images\">\n        <div class=\"hero-img-card\">\n          <picture>\n            <img\n              decoding=\"async\"\n              src=\"https:\/\/www.therapservices.net\/images\/product\/2026\/new-employment\/top-image-260727.png\"\n              alt=\"A picture of a caregiver showing an individual  how to enter data in employment history module\"\n              loading=\"lazy\"\n            \/>\n          <\/picture>\n          <img\n            src=\"https:\/\/therapcanada.ca\/images\/product\/2026\/employment\/hero-section-popout.png\"\n            alt=\"A screenshot of Therap employment module application and interview form\"\n            class=\"hero-overlay-img\"\n            loading=\"lazy\"\n            decoding=\"async\"\n            aria-hidden=\"true\"\n          \/>\n        <\/div>\n      <\/div>\n    <\/div>\n  <\/section>\n\n  <!-- ===== Functionality Section ===== -->\n  <section\n    class=\"functionality\"\n    aria-labelledby=\"functionality-heading\"\n    role=\"region\"\n  >\n    <div class=\"container\">\n      <div class=\"func-grid\">\n        <div class=\"func-images-wrapper\">\n          <div class=\"functionality-header\">\n            <h2 id=\"functionality-heading\" class=\"section-heading\">\n              Functionality\n            <\/h2>\n          <\/div>\n          <div class=\"func-images\">\n            <picture>\n              <source\n                media=\"(max-width: 980px)\"\n                srcset=\"\n                  https:\/\/www.therapservices.net\/images\/product\/2026\/new-employment\/mobile-bg-260727.png\n                \"\n              \/>\n              <img\n                class=\"func-main-img\"\n                decoding=\"async\"\n                src=\"https:\/\/www.therapservices.net\/images\/product\/2026\/new-employment\/mobile-bg-260727.png\"\n                data-orig-src=\"https:\/\/www.therapservices.net\/images\/product\/2026\/new-employment\/mobile-bg-260727.png\"\n                alt=\"A picture of person holidng a mobile phone\"\n                loading=\"lazy\"\n              \/>\n            <\/picture>\n            <img\n              src=\"https:\/\/www.therapservices.net\/images\/product\/2026\/new-employment\/mobile.png\"\n              alt=\"A screenshot showing Therap ISP Data mobile app interface\"\n              class=\"func-overlay-img\"\n              loading=\"lazy\"\n              decoding=\"async\"\n            \/>\n          <\/div>\n          <div class=\"func-list wages-hours-tracking-left\" role=\"list\">\n            <div class=\"line-border\" aria-hidden=\"true\"><\/div>\n            <div class=\"func-item\" role=\"listitem\">\n              <div class=\"func-icon\" aria-hidden=\"true\">\n                <img decoding=\"async\"\n                  src=\"https:\/\/www.therapservices.net\/images\/product\/2026\/new-employment\/Wages-Hours-Tracking.png\"\n                  alt=\"\"\n                \/>\n              <\/div>\n              <div class=\"func-text\">\n                <h3>Wages & Hours Tracking<\/h3>\n                <p>\n                  Easily record and aggregate employment metrics \u2014 such as\n                  hours worked, wages earned, and job types \u2014 to simplify\n                  labour compliance and outcome reporting.\n                <\/p>\n              <\/div>\n            <\/div>\n            <div class=\"line-border\" aria-hidden=\"true\"><\/div>\n          <\/div>\n        <\/div>\n\n        <div class=\"func-list\" role=\"list\">\n          <div class=\"line-border\" aria-hidden=\"true\"><\/div>\n\n          <div class=\"func-item\" role=\"listitem\">\n            <div class=\"func-icon\" aria-hidden=\"true\">\n              <img decoding=\"async\"\n                src=\"https:\/\/www.therapservices.net\/images\/product\/2026\/new-employment\/Career-Discovery-&-Planning.png\"\n                alt=\"\"\n              \/>\n            <\/div>\n            <div class=\"func-text\">\n              <h3>Career Discovery & Planning<\/h3>\n              <p>\n                Document individual preferences, strengths, skills, and\n                situational assessments to build a robust foundation for\n                vocational success.\n              <\/p>\n            <\/div>\n          <\/div>\n          <div class=\"line-border\" aria-hidden=\"true\"><\/div>\n\n          <div class=\"func-item\" role=\"listitem\">\n            <div class=\"func-icon\" aria-hidden=\"true\">\n              <img decoding=\"async\"\n                src=\"https:\/\/www.therapservices.net\/images\/product\/2026\/new-employment\/Job-Development-Tracking.png\"\n                alt=\"\"\n              \/>\n            <\/div>\n            <div class=\"func-text\">\n              <h3>Job Development Tracking<\/h3>\n              <p>\n                Monitor the job search pipeline by logging applications, resume\n                submissions, interview schedules, and follow-ups in one\n                centralized space.\n              <\/p>\n            <\/div>\n          <\/div>\n          <div class=\"line-border\" aria-hidden=\"true\"><\/div>\n\n          <div class=\"func-item\" role=\"listitem\">\n            <div class=\"func-icon\" aria-hidden=\"true\">\n              <img decoding=\"async\"\n                src=\"https:\/\/www.therapservices.net\/images\/product\/2026\/new-employment\/Milestone-Tracking-icon.png\"\n                alt=\"\"\n              \/>\n            <\/div>\n            <div class=\"func-text\">\n              <h3>Milestone Tracking<\/h3>\n              <p>\n                Record job placements and track critical retention benchmarks,\n                such as 30-, 60-, 90-, and 120-day goals, to monitor long-term\n                individual progress and simplify provincial employment-support\n                and CARF compliance reporting.\n              <\/p>\n            <\/div>\n          <\/div>\n          <div class=\"line-border\" aria-hidden=\"true\"><\/div>\n\n          <div class=\"func-item\" role=\"listitem\">\n            <div class=\"func-icon\" aria-hidden=\"true\">\n              <img decoding=\"async\"\n                src=\"https:\/\/www.therapservices.net\/images\/product\/2026\/new-employment\/Employer-Relationship-Management.png\"\n                alt=\"\"\n              \/>\n            <\/div>\n            <div class=\"func-text\">\n              <h3>Employer Relationship Management<\/h3>\n              <p>\n                Maintain a secure, shared database of local employers, contact\n                histories, job openings, and placement records.\n              <\/p>\n            <\/div>\n          <\/div>\n          <div class=\"line-border\" aria-hidden=\"true\"><\/div>\n\n          <div class=\"func-item\" role=\"listitem\">\n            <div class=\"func-icon\" aria-hidden=\"true\">\n              <img decoding=\"async\"\n                src=\"https:\/\/www.therapservices.net\/images\/product\/2026\/new-employment\/Job-skill-icon.png\"\n                alt=\"\"\n              \/>\n            <\/div>\n            <div class=\"func-text\">\n              <h3>Job Coaching & Skill Building<\/h3>\n              <p>\n                Track on\u2011the\u2011job training sessions, workplace\n                accommodations, and skill acquisition to support long\u2011term\n                employee independence.\n              <\/p>\n            <\/div>\n          <\/div>\n          <div class=\"line-border\" aria-hidden=\"true\"><\/div>\n\n          <div class=\"func-item\" role=\"listitem\">\n            <div class=\"func-icon\" aria-hidden=\"true\">\n              <img decoding=\"async\"\n                src=\"https:\/\/www.therapservices.net\/images\/product\/2026\/new-employment\/Point-of-Service-ISP-Data-Collection.png\"\n                alt=\"\"\n              \/>\n            <\/div>\n            <div class=\"func-text\">\n              <h3>Point-of-Service Data Collection<\/h3>\n              <p>\n                Track individual goal progress, task analysis, and specific\n                vocational milestones directly from the job site, turning\n                community interactions into measurable ISP data.\n              <\/p>\n            <\/div>\n          <\/div>\n          <div class=\"line-border\" aria-hidden=\"true\"><\/div>\n\n          <div class=\"func-item wages-hours-tracking\" role=\"listitem\">\n            <div class=\"func-icon\" aria-hidden=\"true\">\n              <img decoding=\"async\"\n                src=\"https:\/\/www.therapservices.net\/images\/product\/2026\/new-employment\/Wages-Hours-Tracking.png\"\n                alt=\"\"\n              \/>\n            <\/div>\n            <div class=\"func-text\">\n              <h3>Wages & Hours Tracking<\/h3>\n              <p>\n                Easily record and aggregate employment metrics \u2014 such as\n                hours worked, wages earned, and job types \u2014 to simplify\n                labour compliance and outcome reporting.\n              <\/p>\n            <\/div>\n          <\/div>\n          <div\n            class=\"line-border wages-hours-tracking\"\n            aria-hidden=\"true\"\n          ><\/div>\n        <\/div>\n      <\/div>\n    <\/div>\n  <\/section>\n\n  <!-- ===== Benefits Section ===== -->\n  <section class=\"benefits\" aria-labelledby=\"benefits-heading\" role=\"region\">\n    <div class=\"container\">\n      <h2 id=\"benefits-heading\" class=\"section-heading\">Benefits<\/h2>\n\n      <div class=\"benefits-inner\">\n        <div class=\"benefits-list\" role=\"list\">\n          <div class=\"benefit-card\" role=\"listitem\">\n            <div class=\"benefit-icon\" aria-hidden=\"true\">\n              <img\n                decoding=\"async\"\n                src=\"https:\/\/www.therapservices.net\/images\/product\/2026\/billing\/tick-benefits.png\"\n                alt=\"\"\n              \/>\n            <\/div>\n            <div class=\"benefit-card-content\">\n              <h3>Drive Better Employment Outcomes<\/h3>\n              <p>Move from scattered spreadsheets to actionable data.<\/p>\n            <\/div>\n          <\/div>\n          <div class=\"benefit-card\" role=\"listitem\">\n            <div class=\"benefit-icon\" aria-hidden=\"true\">\n              <img\n                decoding=\"async\"\n                src=\"https:\/\/www.therapservices.net\/images\/product\/2026\/billing\/tick-benefits.png\"\n                alt=\"\"\n              \/>\n            <\/div>\n            <div class=\"benefit-card-content\">\n              <h3>Easier Reporting and Tracking<\/h3>\n              <p>\n                Streamline compliance with comprehensive reporting on wages,\n                hours worked, and individual milestones. Easily generate the\n                aggregate data required for provincial, territorial and federal\n                funding without administrative hassle.\n              <\/p>\n            <\/div>\n          <\/div>\n\n          <div class=\"benefit-card\" role=\"listitem\">\n            <div class=\"benefit-icon\" aria-hidden=\"true\">\n              <img\n                decoding=\"async\"\n                src=\"https:\/\/www.therapservices.net\/images\/product\/2026\/billing\/tick-benefits.png\"\n                alt=\"\"\n              \/>\n            <\/div>\n            <div class=\"benefit-card-content\">\n              <h3>Organization and Agency Communication<\/h3>\n              <p>Break down communication silos across your team.<\/p>\n            <\/div>\n          <\/div>\n        <\/div>\n\n        <div class=\"benefits-screenshots\" aria-hidden=\"true\">\n          <img\n            decoding=\"async\"\n            src=\"https:\/\/therapcanada.ca\/images\/product\/2026\/employment\/benefits-tablet.png\"\n            alt=\"A screenshot of Therap employment module job template\"\n            loading=\"lazy\"\n          \/>\n          <!-- <img\n            src=\"https:\/\/www.therapservices.net\/images\/product\/2026\/new-employment\/Employed%20Individual%20by%20Year%20and%20Month.png\"\n            alt=\"A screenshot of Therap employment module showing a graph chart of employment data\"\n            class=\"tab-overlay-img-1\"\n            loading=\"lazy\"\n            decoding=\"async\"\n          \/>\n          <img\n            src=\"https:\/\/www.therapservices.net\/images\/product\/2026\/new-employment\/Individual%20Count%20by%20Job%20Category%20Year.png\"\n            alt=\"A screenshot of Therap employment module showing individual count in bar format\"\n            class=\"tab-overlay-img-2\"\n            loading=\"lazy\"\n            decoding=\"async\"\n          \/> -->\n        <\/div>\n      <\/div>\n    <\/div>\n  <\/section>\n\n  <!-- ===== FAQ Section ===== -->\n  <section class=\"faq\" aria-labelledby=\"faq-heading\" role=\"region\">\n    <div class=\"container\">\n      <h2 id=\"faq-heading\" class=\"section-heading\">\n        Frequently Asked Questions\n      <\/h2>\n\n      <div class=\"faq-columns\">\n        <div class=\"faq-column\">\n          <!-- Accordion 1 -->\n          <details class=\"faq-item\" id=\"emp-acc-1\">\n            <summary class=\"faq-summary\">\n              <span class=\"faq-question\" id=\"emp-acc-heading-1\"\n                >Which stages of the employment process can agencies track in\n                Therap?<\/span\n              >\n              <img decoding=\"async\"\n                src=\"https:\/\/www.therapservices.net\/images\/product\/2026\/plus-icon-FAQ-2026.png\"\n                class=\"faq-icon faq-icon-plus\"\n                alt=\"\"\n                aria-hidden=\"true\"\n              \/>\n              <img decoding=\"async\"\n                src=\"https:\/\/www.therapservices.net\/images\/product\/2026\/minus-icon-FAQ-2026.png\"\n                class=\"faq-icon faq-icon-minus\"\n                alt=\"\"\n                aria-hidden=\"true\"\n              \/>\n            <\/summary>\n            <div class=\"faq-content\" id=\"emp-acc-body-1\">\n              <p>\n                Therap provides documentation tools for the full employment\n                lifecycle \u2014 career discovery, job development leads,\n                placement records, coaching notes, and long-term wages and\n                hours.\n              <\/p>\n            <\/div>\n          <\/details>\n\n          <!-- Accordion 2 -->\n          <details class=\"faq-item\" id=\"emp-acc-2\">\n            <summary class=\"faq-summary\">\n              <span class=\"faq-question\" id=\"emp-acc-heading-2\"\n                >How does this module improve communication across our agency's\n                team?<\/span\n              >\n              <img decoding=\"async\"\n                src=\"https:\/\/www.therapservices.net\/images\/product\/2026\/plus-icon-FAQ-2026.png\"\n                class=\"faq-icon faq-icon-plus\"\n                alt=\"\"\n                aria-hidden=\"true\"\n              \/>\n              <img decoding=\"async\"\n                src=\"https:\/\/www.therapservices.net\/images\/product\/2026\/minus-icon-FAQ-2026.png\"\n                class=\"faq-icon faq-icon-minus\"\n                alt=\"\"\n                aria-hidden=\"true\"\n              \/>\n            <\/summary>\n            <div class=\"faq-content\" id=\"emp-acc-body-2\">\n              <p>\n                Centralized employer databases, comprehensive individual\n                employment journeys, and integrated daily notes keep job\n                coaches, developers, and management aligned.\n              <\/p>\n            <\/div>\n          <\/details>\n\n          <!-- Accordion 3 -->\n          <details class=\"faq-item\" id=\"emp-acc-3\">\n            <summary class=\"faq-summary\">\n              <span class=\"faq-question\" id=\"emp-acc-heading-3\"\n                >Can we use this module to track employment outcomes and\n                wage\/hour metrics for funding compliance?<\/span\n              >\n              <img decoding=\"async\"\n                src=\"https:\/\/www.therapservices.net\/images\/product\/2026\/plus-icon-FAQ-2026.png\"\n                class=\"faq-icon faq-icon-plus\"\n                alt=\"\"\n                aria-hidden=\"true\"\n              \/>\n              <img decoding=\"async\"\n                src=\"https:\/\/www.therapservices.net\/images\/product\/2026\/minus-icon-FAQ-2026.png\"\n                class=\"faq-icon faq-icon-minus\"\n                alt=\"\"\n                aria-hidden=\"true\"\n              \/>\n            <\/summary>\n            <div class=\"faq-content\" id=\"emp-acc-body-3\">\n              <p>\n                Yes. The system tracks key data points required by provincial\n                funding sources, including employment type, wage rates, and\n                hours worked.\n              <\/p>\n            <\/div>\n          <\/details>\n        <\/div>\n\n        <div class=\"faq-column\">\n          <!-- Accordion 4 -->\n          <details class=\"faq-item\" id=\"emp-acc-4\">\n            <summary class=\"faq-summary\">\n              <span class=\"faq-question\" id=\"emp-acc-heading-4\"\n                >How do job coaches document services while on-site with an\n                individual?<\/span\n              >\n              <img decoding=\"async\"\n                src=\"https:\/\/www.therapservices.net\/images\/product\/2026\/plus-icon-FAQ-2026.png\"\n                class=\"faq-icon faq-icon-plus\"\n                alt=\"\"\n                aria-hidden=\"true\"\n              \/>\n              <img decoding=\"async\"\n                src=\"https:\/\/www.therapservices.net\/images\/product\/2026\/minus-icon-FAQ-2026.png\"\n                class=\"faq-icon faq-icon-minus\"\n                alt=\"\"\n                aria-hidden=\"true\"\n              \/>\n            <\/summary>\n            <div class=\"faq-content\" id=\"emp-acc-body-4\">\n              <p>\n                Job coaches can securely access Therap via web browsers or\n                mobile devices.\n              <\/p>\n            <\/div>\n          <\/details>\n\n          <!-- Accordion 5 -->\n          <details class=\"faq-item\" id=\"emp-acc-5\">\n            <summary class=\"faq-summary\">\n              <span class=\"faq-question\" id=\"emp-acc-heading-5\"\n                >Does the Employment Services module integrate with the rest of\n                the Therap platform?<\/span\n              >\n              <img decoding=\"async\"\n                src=\"https:\/\/www.therapservices.net\/images\/product\/2026\/plus-icon-FAQ-2026.png\"\n                class=\"faq-icon faq-icon-plus\"\n                alt=\"\"\n                aria-hidden=\"true\"\n              \/>\n              <img decoding=\"async\"\n                src=\"https:\/\/www.therapservices.net\/images\/product\/2026\/minus-icon-FAQ-2026.png\"\n                class=\"faq-icon faq-icon-minus\"\n                alt=\"\"\n                aria-hidden=\"true\"\n              \/>\n            <\/summary>\n            <div class=\"faq-content\" id=\"emp-acc-body-5\">\n              <p>\n                Absolutely \u2014 it integrates with individual demographics,\n                daily documentation, and reporting.\n              <\/p>\n            <\/div>\n          <\/details>\n        <\/div>\n      <\/div>\n    <\/div>\n  <\/section>\n<\/main>\n<script src=\"https:\/\/www.google.com\/recaptcha\/api.js\" async defer><\/script>\r\n<!--  Styling for the modal + form lives in landing-form-modal.css  -->\r\n<!--  ----------------------------------------------------------------------  -->\r\n<!--  NOTE: Please add the following <META> element to your page <HEAD>.      -->\r\n<!--  If necessary, please modify the charset parameter to specify the        -->\r\n<!--  character set of your HTML page.                                        -->\r\n<!--  ----------------------------------------------------------------------  -->\r\n\r\n<meta http-equiv=\"Content-type\" content=\"text\/html; charset=UTF-8\" \/>\r\n\r\n<!--  ----------------------------------------------------------------------  -->\r\n<!--  NOTE: Please add the following <FORM> element to your page.             -->\r\n<!--  ----------------------------------------------------------------------  -->\r\n\r\n<div id=\"custom-modal\" class=\"custom-modal\">\r\n  <div class=\"custom-modal-dialog\">\r\n    <div class=\"custom-modal-content\">\r\n      <div class=\"close-modal\" role=\"button\" aria-label=\"Close\">\r\n        <span class=\"round\">X<\/span>\r\n      <\/div>\r\n      <div class=\"custom-modal-body\">\r\n        <h2 class=\"model-heading\">Contact our team<\/h2>\r\n<form\r\n  id=\"salesforce_form\"\r\n  name=\"form1\"\r\n  action=\"https:\/\/webto.salesforce.com\/servlet\/servlet.WebToLead?encoding=UTF-8\"\r\n  method=\"POST\"\r\n  onSubmit=\"return checkbae()\"\r\n>\r\n  <input type=\"hidden\" name=\"oid\" value=\"00Di0000000GyrQ\" \/>\r\n  <input\r\n    type=\"hidden\"\r\n    name=\"retURL\"\r\n    value=\"https:\/\/www.therapcanada.ca\/thankyou\/landing-page-thank-you.php\"\r\n  \/>\r\n\r\n  <!--  ----------------------------------------------------------------------  -->\r\n  <!--  NOTE: These fields are optional debugging elements. Please uncomment    -->\r\n  <!--  these lines if you wish to test in debug mode.                          -->\r\n  <!--  <input type=\"hidden\" name=\"debug\" value=1>                              -->\r\n  <!--  <input type=\"hidden\" name=\"debugEmail\"                                  -->\r\n  <!--  value=\"wareskhan@therapservices.net\">                                   -->\r\n  <!--  ----------------------------------------------------------------------  -->\r\n  <input type=\"hidden\" name=\"lead_source\" value=\"Web\" \/>\r\n  <label for=\"first_name\">First Name<span class=\"required-star\">*<\/span><\/label\r\n  ><input\r\n    id=\"first_name\"\r\n    maxlength=\"40\"\r\n    name=\"first_name\"\r\n    size=\"20\"\r\n    type=\"text\"\r\n    required\r\n  \/><br \/>\r\n\r\n  <label for=\"last_name\">Last Name<span class=\"required-star\">*<\/span><\/label\r\n  ><input\r\n    id=\"last_name\"\r\n    maxlength=\"80\"\r\n    name=\"last_name\"\r\n    size=\"20\"\r\n    type=\"text\"\r\n    required\r\n  \/><br \/>\r\n\r\n  <label for=\"title\">Title<span class=\"required-star\">*<\/span><\/label\r\n  ><input\r\n    id=\"title\"\r\n    maxlength=\"40\"\r\n    name=\"title\"\r\n    size=\"20\"\r\n    type=\"text\"\r\n    required\r\n  \/><br \/>\r\n\r\n  <label for=\"company\">Company<\/label\r\n  ><input\r\n    id=\"company\"\r\n    maxlength=\"40\"\r\n    name=\"company\"\r\n    size=\"20\"\r\n    type=\"text\"\r\n  \/><br \/>\r\n\r\n  <label for=\"email\">Email<span class=\"required-star\">*<\/span><\/label\r\n  ><input id=\"email\" maxlength=\"80\" name=\"email\" size=\"20\" type=\"text\" \/>\r\n  <p id=\"emailval\" style=\"display: none; color: red\">Email is not valid<\/p>\r\n\r\n  <label for=\"phone\">Phone<\/label\r\n  ><input id=\"phone\" maxlength=\"40\" name=\"phone\" size=\"20\" type=\"text\" \/><br \/>\r\n\r\n  <label for=\"state\">Province<span class=\"required-star\">*<\/span><\/label>\r\n  <select name=\"state\" id=\"state\" required>\r\n    <option value=\"\" selected=\"selected\" style=\"color: #000000\">\r\n      Select a Province\r\n    <\/option>\r\n    <option value=\"AB\">Alberta<\/option>\r\n    <option value=\"BC\">British Columbia<\/option>\r\n    <option value=\"MB\">Manitoba<\/option>\r\n    <option value=\"NB\">New Brunswick<\/option>\r\n    <option value=\"NL\">Newfoundland and Labrador<\/option>\r\n    <option value=\"NT\">Northwest Territories<\/option>\r\n    <option value=\"NS\">Nova Scotia<\/option>\r\n    <option value=\"NU\">Nunavut<\/option>\r\n    <option value=\"ON\">Ontario<\/option>\r\n    <option value=\"PE\">Prince Edward Island<\/option>\r\n    <option value=\"QC\">Quebec<\/option>\r\n    <option value=\"SK\">Saskatchewan<\/option>\r\n    <option value=\"YT\">Yukon<\/option>\r\n  <\/select>\r\n\r\n  <input\r\n    id=\"00N0H00000K4t5R\"\r\n    maxlength=\"255\"\r\n    name=\"00N0H00000K4t5R\"\r\n    size=\"20\"\r\n    type=\"hidden\"\r\n  \/>\r\n\r\n  <label for=\"g-recaptcha-response\" title=\"\" style=\"display: none\">label<\/label>\r\n  <div\r\n    class=\"g-recaptcha\"\r\n    data-sitekey=\"6Lfly_IUAAAAAE6SmfUH34T1IzFyLNxerjdGet-2\"\r\n  ><\/div>\r\n  <p id=\"recaptchavalid\" style=\"display: none; 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