Dempsey Center Tablet Request Form

Please complete this form for each person you refer to the Dempsey Center Tablet Program.

  • If the individual has their own device, please enter there name here as well.
    If none or insufficient internet access, they will receive a data tablet.
    If they have their own device but need assistance with learning how to use it for telehealth, please select "Other" and enter "Need ILP to learn to use a (name of device).