Back Up Therapy — Provider Product Consent Form (V225)

Thank you for supporting occupational therapists — we’re excited to explore your products and make them more accessible to the families and therapists we support. Please complete this consent form to confirm permission for your products to be included in Back Up Therapy kits. The form allows you to specify which products are covered and the permissions you wish to grant. By digitally signing and sending, you acknowledge and agree to our Terms & Conditions of Use (provided below the consent form), helping us ensure clarity and transparency in how your products are shared and promoted. By signing below, I confirm that I am authorised to provide permission for the use of the specified products as outlined in this form and agree to the Back Up Therapy Terms & Conditions of Use.