{"id":13181,"date":"2026-10-19T03:54:09","date_gmt":"2026-10-19T03:54:09","guid":{"rendered":"https:\/\/www.therapcanada.ca\/products\/?page_id=13181"},"modified":"2026-10-29T02:35:18","modified_gmt":"2026-10-29T02:35:18","slug":"waiting-priority-list-solution","status":"publish","type":"page","link":"https:\/\/www.therapcanada.ca\/products\/waiting-priority-list-solution\/","title":{"rendered":"Waiting &#038; Priority List Solution"},"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 id=\"pwl-main\" role=\"main\" aria-labelledby=\"pwl-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's Priority and Waiting List module is a secure, cloud-based tool that\n    centralizes intake tracking for developmental services and community living\n    providers in Canada, helping agencies manage program waitlists clearly and\n    confidently.\n  <\/div>\n\n  <!-- \u2500\u2500\u2500 SECTION 1: HERO \u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500 -->\n  <section class=\"hero\" aria-labelledby=\"pwl-main-heading\">\n    <div class=\"hero-container\">\n      <div class=\"hero-images\">\n        <div class=\"hero-img-card\">\n          <picture>\n            <img decoding=\"async\"\n              class=\"hero-main-photo\"\n              src=\"https:\/\/www.therapcanada.ca\/\/images\/product\/2026\/priority-waiting-list\/top-hero-image-priority-list-2026.png\"\n              alt=\"\"\n            \/>\n          <\/picture>\n          <img\n            src=\"https:\/\/www.therapservices.net\/images\/product\/2026\/priority-waiting-list\/priority-list-residential-pop-out-2026.png\"\n            alt=\"\"\n            class=\"hero-overlay-screenshot\"\n            loading=\"lazy\"\n            decoding=\"async\"\n          \/>\n        <\/div>\n      <\/div>\n\n      <div class=\"hero-content\">\n        <h1 id=\"pwl-main-heading\" class=\"hero-section-heading\">\n          Priority & Waiting List Management Software for Developmental Services\n          and Community\u00a0Living\u00a0Providers\n        <\/h1>\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's Priority & Waiting List Management Software centralizes each\n          applicant's intake status, replacing scattered spreadsheets and\n          physical folders with one secure, shared view your whole team can rely\n          on. Connecting individuals with community living, day programs, and\n          supported residential services requires clear tracking from the very\n          first contact. Therap provides intake specialists, service\n          coordinators, and administrative leaders with a unified platform to\n          see exactly who needs supports next and transition individuals\n          seamlessly into\u00a0care.\n        <\/p>\n      <\/div>\n    <\/div>\n  <\/section>\n\n  <!-- \u2500\u2500\u2500 SECTION 2: FUNCTIONALITY \u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500 -->\n  <section\n    class=\"functionality\"\n    aria-labelledby=\"functionality-heading\"\n    role=\"region\"\n  >\n    <div class=\"container\">\n      <h2 id=\"functionality-heading\" class=\"section-heading\">Functionality<\/h2>\n\n      <div class=\"tools-grid\" role=\"list\">\n        <!-- Tool 1 -->\n        <div class=\"tool-item\" role=\"listitem\">\n          <div class=\"tool-item-header\">\n            <div class=\"tool-icon\" aria-hidden=\"true\">\n              <img decoding=\"async\"\n                src=\"https:\/\/www.therapservices.net\/images\/product\/2026\/priority-waiting-list\/manage-muliple-service-lists-icon.png\"\n                alt=\"\"\n              \/>\n            <\/div>\n            <h3>Manage Multiple Service Lists<\/h3>\n          <\/div>\n          <p>\n            Categorize waitlists by specific programs (e.g., residential, day\n            supports, respite, supported employment), eligibility criteria,\n            provincial funding streams, or regional\u00a0branches.\n          <\/p>\n        <\/div>\n\n        <!-- Tool 2 -->\n        <div class=\"tool-item\" role=\"listitem\">\n          <div class=\"tool-item-header\">\n            <div class=\"tool-icon\" aria-hidden=\"true\">\n              <img decoding=\"async\"\n                src=\"https:\/\/www.therapservices.net\/images\/product\/2026\/priority-waiting-list\/log-applicant-communication-icon.png\"\n                alt=\"\"\n              \/>\n            <\/div>\n            <h3>Log Applicant Communications<\/h3>\n          <\/div>\n          <p>\n            Document timestamped contact notes, phone calls, family meetings,\n            and community partner consultations in a single\n            central\u00a0location.\n          <\/p>\n        <\/div>\n\n        <!-- Tool 3 -->\n        <div class=\"tool-item\" role=\"listitem\">\n          <div class=\"tool-item-header\">\n            <div class=\"tool-icon\" aria-hidden=\"true\">\n              <img decoding=\"async\"\n                src=\"https:\/\/www.therapservices.net\/images\/product\/2026\/priority-waiting-list\/assign-priority-levels-icon.png\"\n                alt=\"\"\n              \/>\n            <\/div>\n            <h3>Assign Priority Levels<\/h3>\n          <\/div>\n          <p>\n            Set configurable priority ratings based on assessed individual need,\n            referral date, regional access agency recommendations, or\n            support\u00a0urgency.\n          <\/p>\n        <\/div>\n\n        <!-- Tool 4 -->\n        <div class=\"tool-item\" role=\"listitem\">\n          <div class=\"tool-item-header\">\n            <div class=\"tool-icon\" aria-hidden=\"true\">\n              <img decoding=\"async\"\n                src=\"https:\/\/www.therapservices.net\/images\/product\/2026\/priority-waiting-list\/attach-intake-assesment-icon.png\"\n                alt=\"\"\n              \/>\n            <\/div>\n            <h3>Attach Intake Assessments<\/h3>\n          <\/div>\n          <p>\n            Link intake questionnaires, eligibility evaluations, medical\n            assessments, and consent forms directly to applicant\u00a0profiles.\n          <\/p>\n        <\/div>\n\n        <!-- Tool 5 -->\n        <div class=\"tool-item\" role=\"listitem\">\n          <div class=\"tool-item-header\">\n            <div class=\"tool-icon\" aria-hidden=\"true\">\n              <img decoding=\"async\"\n                src=\"https:\/\/www.therapservices.net\/images\/product\/2026\/priority-waiting-list\/track-service-transitions-icon.png\"\n                alt=\"\"\n              \/>\n            <\/div>\n            <h3>Track Service Transitions<\/h3>\n          <\/div>\n          <p>\n            Manage incoming community referrals, active individuals seeking\n            additional or specialized programs, and former participants looking\n            to re\u2011enter\u00a0services.\n          <\/p>\n        <\/div>\n\n        <!-- Tool 6 -->\n        <div class=\"tool-item\" role=\"listitem\">\n          <div class=\"tool-item-header\">\n            <div class=\"tool-icon\" aria-hidden=\"true\">\n              <img decoding=\"async\"\n                src=\"https:\/\/www.therapservices.net\/images\/product\/2026\/priority-waiting-list\/generate-trend-report-icon.png\"\n                alt=\"\"\n              \/>\n            <\/div>\n            <h3>Generate Reports<\/h3>\n          <\/div>\n          <p>\n            Review waitlist metrics and demographic data to evaluate program\n            capacity, submit ministry reports, and forecast future\n            community\u00a0demand.\n          <\/p>\n        <\/div>\n      <\/div>\n    <\/div>\n  <\/section>\n\n  <!-- \u2500\u2500\u2500 SECTION 3: BENEFITS \u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500 -->\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        <!-- Benefits list LEFT -->\n        <div class=\"benefits-list\" role=\"list\">\n          <div class=\"benefit-card\" role=\"listitem\">\n            <div class=\"benefit-card-header\">\n              <div class=\"benefit-icon\" aria-hidden=\"true\">\n                <img decoding=\"async\"\n                  src=\"https:\/\/www.therapservices.net\/images\/product\/2026\/billing\/tick-benefits.png\"\n                  alt=\"\"\n                \/>\n              <\/div>\n              <h3>Reduce Administrative Confusion<\/h3>\n            <\/div>\n            <p>\n              Replace scattered paper files and uncoordinated spreadsheets with\n              a shared digital workspace for intake staff, service coordinators,\n              and program\u00a0managers.\n            <\/p>\n          <\/div>\n\n          <div class=\"benefit-card\" role=\"listitem\">\n            <div class=\"benefit-card-header\">\n              <div class=\"benefit-icon\" aria-hidden=\"true\">\n                <img decoding=\"async\"\n                  src=\"https:\/\/www.therapservices.net\/images\/product\/2026\/billing\/tick-benefits.png\"\n                  alt=\"\"\n                \/>\n              <\/div>\n              <h3>Improve Placement Timelines<\/h3>\n            <\/div>\n            <p>\n              Quickly identify individuals with urgent support needs so\n              coordinators can fill residential vacancies and program openings\n              without\u00a0delay.\n            <\/p>\n          <\/div>\n\n          <div class=\"benefit-card\" role=\"listitem\">\n            <div class=\"benefit-card-header\">\n              <div class=\"benefit-icon\" aria-hidden=\"true\">\n                <img decoding=\"async\"\n                  src=\"https:\/\/www.therapservices.net\/images\/product\/2026\/billing\/tick-benefits.png\"\n                  alt=\"\"\n                \/>\n              <\/div>\n              <h3>Maintain Clear, Comprehensive Records<\/h3>\n            <\/div>\n            <p>\n              Store complete historical records\u2014including intake\n              documents, questionnaires, and communication logs\u2014supporting\n              team handoffs and compliance with provincial quality standards.\n            <\/p>\n          <\/div>\n        <\/div>\n\n        <!-- Photo RIGHT -->\n        <div class=\"benefits-photo\">\n          <img decoding=\"async\"\n            class=\"benefits-main-img\"\n            src=\"https:\/\/www.therapcanada.ca\/images\/product\/2026\/priority-waiting-list\/benefits-section.png\"\n            alt=\"\"\n            loading=\"lazy\"\n          \/>\n          <img\n            src=\"https:\/\/www.therapservices.net\/images\/product\/2026\/priority-waiting-list\/pop-out-residential-survey-for-idd-service-2026-updated.png\"\n            alt=\"\"\n            class=\"benefits-overlay-bottom\"\n            loading=\"lazy\"\n            decoding=\"async\"\n          \/>\n        <\/div>\n      <\/div>\n    <\/div>\n  <\/section>\n\n  <!-- \u2500\u2500\u2500 SECTION 4: FAQ \u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500 -->\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=\"acc-1\">\n            <summary class=\"faq-summary\">\n              <span class=\"faq-question\" id=\"acc-heading-1\">\n                What is the Therap Priority List module?\n              <\/span>\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=\"acc-body-1\">\n              <p>\n                It is a secure, cloud\u2011based tool designed to help\n                developmental services providers, community living agencies, and\n                intake coordinators track applicants, manage program waitlists,\n                and document all interactions with individuals seeking services.\n              <\/p>\n            <\/div>\n          <\/details>\n\n          <!-- Accordion 2 -->\n          <details class=\"faq-item\" id=\"acc-2\">\n            <summary class=\"faq-summary\">\n              <span class=\"faq-question\" id=\"acc-heading-2\">\n                Who can access and update Priority Lists in Therap?\n              <\/span>\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=\"acc-body-2\">\n              <p>\n                Access is governed by customizable, role\u2011based user\n                privileges. Authorized administrators, intake specialists, and\n                program supervisors can view, update, and manage lists according\n                to their assigned permissions, safeguarding applicant privacy in\n                compliance with PIPEDA and provincial health information\n                regulations.\n              <\/p>\n            <\/div>\n          <\/details>\n\n          <!-- Accordion 5 -->\n          <details class=\"faq-item\" id=\"acc-5\">\n            <summary class=\"faq-summary\">\n              <span class=\"faq-question\" id=\"acc-heading-5\">\n                Can intake questionnaires and forms be attached to waitlist\n                profiles?\n              <\/span>\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=\"acc-body-5\">\n              <p>\n                Yes. Configurable questionnaires, provincial intake\n                documentation, and supporting eligibility files can be uploaded\n                directly to an applicant's Priority List record to maintain a\n                comprehensive intake file.\n              <\/p>\n            <\/div>\n          <\/details>\n        <\/div>\n\n        <div class=\"faq-column\">\n          <!-- Accordion 3 -->\n          <details class=\"faq-item\" id=\"acc-3\">\n            <summary class=\"faq-summary\">\n              <span class=\"faq-question\" id=\"acc-heading-3\">\n                Can our agency maintain separate lists for different programs?\n              <\/span>\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=\"acc-body-3\">\n              <p>\n                Yes. Agencies can configure multiple priority lists based on\n                program types (e.g., Supported Independent Living, group living,\n                day options), provincial funding streams (such as Passport,\n                FSCD, or ministry base allocations), or regional delivery zones.\n              <\/p>\n            <\/div>\n          <\/details>\n\n          <!-- Accordion 4 -->\n          <details class=\"faq-item\" id=\"acc-4\">\n            <summary class=\"faq-summary\">\n              <span class=\"faq-question\" id=\"acc-heading-4\">\n                How does the system record interactions with applicants?\n              <\/span>\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=\"acc-body-4\">\n              <p>\n                Staff can log detailed contact notes for phone calls, intake\n                meetings, virtual consultations, and communications with\n                applicants, family members, advocates, or regional\n                ministry\/access partners (such as Developmental Services Ontario\n                or Community Living BC) directly on the individual's profile.\n              <\/p>\n            <\/div>\n          <\/details>\n\n          <!-- Accordion 6 -->\n          <details class=\"faq-item\" id=\"acc-6\">\n            <summary class=\"faq-summary\">\n              <span class=\"faq-question\" id=\"acc-heading-6\">\n                How does the module support long\u2011term agency planning?\n              <\/span>\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=\"acc-body-6\">\n              <p>\n                Built\u2011in reporting tools allow leadership to evaluate\n                overall waitlist volume, track service demand trends across\n                programs, and analyze capacity utilization to inform staffing\n                models, operational budgets, and provincial funding proposals.\n              <\/p>\n            <\/div>\n          <\/details>\n        <\/div>\n      <\/div>\n    <\/div>\n  <\/section>\n<\/main>\n\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; 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