QTF Custom Keyguard Request

Please complete the following form for each Custom Keyguard you would like for your QuickTalker Freestyle
Please note: It is recommended you have the QuickTalker Freestyle in hand to complete the form as accurately as possible.
For help finding your funding request number, use Find My FN.
Reference No.
FN######
Speech-Language Pathologist Requesting Keyguard
First Name
Last Name
Mobile Phone Number
Format: (000) 000-0000.
SMS Checkmark - hidden
Email
Best way to reach you
I am a
I work at a
Ship-To Information
Company / School / Clinic Name:
Attention to

First NameLast Name
Address
Address
Address 1
Address 2
City
State
Zip Code
Keyguard Information
Who is the keyguard for?

Client First NameClient Last Name
Family Contact / Legal Guardian email
example@example.com
Is this keyguard for your ableEXPERIENCE device?
iPad Size
Keyguard Color
How many of this keyguard layout will you need?
Does your case have one or more QR codes on the kickstand?
Select AAC app
Select AAC app
Touchchat w/ Wordpower Layout Sub-Category and Name
If you have your Speech Display Bar Show Icons setting turned ON, select "I would like to make changes" below and enter the text "Speech Display Bar Show Icons setting turned On". We will adjust the layout and send you a proof to review.
TD Snap Layout Sub-Category and Name
LAMP Words for Life Layout Name
Proloquo2Go Sub-Category and Layout Name
Integrated Touchchat w/ Wordpower Layout Sub-Category and Name
Integrated TD Snap Layout Sub-Category and Name
Integrated Proloquo2Go Sub-Category and Layout Name
Integrated LAMP Words for Life Layout Name
Cough Drop Layout Name
GoTalk NOW Layout Name
Grid for Ipad Layout Name
LAMP Words for Life Layout Name
Proloquo2Go Layout Name
Speak for Yourself Layout Name
TD Snap Layout Name
TouchChat Layout Name
Keyguard Preview
Integrated LAMP
TouchChat
TD Snap
Integrated Proloquo2Go
10.9 Cough Drop
10.9 GoTalk Now
10.9 Grid for Ipad
10.9 LAMP
10.9 Proloquo2Go
10.9 Speak For Yourself
10.9 TD Snap
10.9 TouchChat
Would you like the keyguard as shown or would you like to make alterations?
Please Note- By Acknowledging, you understand that ableCARE will not be in contact with you and your keyguard will be automatically shipped out.
File Name (old)
Other app name
App Layout (e.g. WordPower 60, MultiChat 15, grid size 7x11, etc.)
Do you have physical access to the device to obtain a screenshot of the app layout?
Upload a screen shot of the requested keyguard.

Although this information is optional, uploading a screenshot is helpful to ensure we have the proper information.
Cancelof
What would you like to change on this keyguard request?

0/255
Additional comments

0/255
File Name
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Please complete the following form for each Custom Keyguard you would like for your QuickTalker Freestyle

Speech-Language Pathologist Requesting Keyguard

Ship-To Information

Keyguard Information

Keyguard Preview

Integrated LAMP

TouchChat

TD Snap

Integrated Proloquo2Go

10.9 Cough Drop

10.9 GoTalk Now

10.9 Grid for Ipad

10.9 LAMP

10.9 Proloquo2Go

10.9 Speak For Yourself

10.9 TD Snap

10.9 TouchChat