Enter your information to complete your QuickTalker Freestyle Custom Keyguard request
Please provide accurate contact information so we can ensure you receive the requested information.
Reference No.
FN######
Speech-Language Pathologist Requesting Keyguard
First Name
*
Last Name
*
Mobile Phone Number
*
SMS Checkmark - hidden
Yes
Email
*
Best way to reach you
*
Please Select
Phone
Email
Either
I am a
*
Please Select
Speech-Language Pathologist
Assistive Technology Coordinator
Other
I work at a
*
Please Select
School
Clinic/Hospital/Private Practice
Other
Ship-To Information
Company / School / Clinic Name:
Attention to
*
First Name
Last Name
Address
*
Address 1
Address 2
City
*
State
*
Please Select
AL
AK
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip Code
*
Keyguard Information
Who is the keyguard for?
*
Client First Name
Client Last Name
Family Contact / Legal Guardian email
*
example@example.com
Is this keyguard for a trial device?
*
Please Select
Yes
No
iPad Size
*
Choose hardware bundle
10.2” QuickTalker Freestyle
8.3” QuickTalker Freestyle Mini
Select AAC app
*
App choice
Proloquo2Go
TouchChat HD - AAC with WordPower
LAMP - Words for Life
TD Snap AAC
Other
Touchchat w/ Wordpower Layout Sub-Category and Name
*
Please Select
4 Basic SS (2x2)
Spelling SS (5x10)
VocabPC SS (3x4)
MultiChat 15 Adolescent SS (3x5)
MultiChat 15 Adult SS (3x5)
My QuickChat Adult 12 SS (4x4)
My QuickChat Adult 8 SS
My QuickChat Child 12 SS (4x4)
My QuickChat Child 4 SS
My QuickChat Child 8
WordPower 20 Simply SS (4x5)
WordPower25 Touch & Scan SS (5x5)
WordPower42 Basic SS (6x7)
WordPower42 SS (6x7)
WordPower48 SS (6x8)
WordPower60 Basic SS (6x10)
WordPower60 SS (6x10)
WordPower80 SS (8x10)
WordPower 48 Espanol SS (6x8)
WordPower25 Espanol SS (5x5)
WordPower48 Espanol Basico SS (6x8)
WordPower60 Espanol Baciso SS (6x10)
WordPower60 Francais SS (6x10)
sin sintaxis 4x4 English SS (4x4)
sin sintaxis 4x4 Spanish SS (4x4)
sintaxis 4x5 English SS (5x4)
sintaxis 4x5 Spanish (5x4)
Teclado SS (5x11)
Vocab PC Spanish SS (3x4)
4 de base francais SS (2x2)
VocabPC francais SS (3x4)
Other
TD Snap Layout Sub-Category and Name
*
Please Select
Aphasia 3x3
Aphasia 4x3
Aphasia 6x5
Core First 3x4
Core First 5x5
Core First 7x7
Core First 8x10
Motor Plan 30 (5x5)
Motor Plan 66 (6x10)
Motor Plan 30 Bilingual Spanish/English (United States) (5x5)
Motor Plan 66 Bilingual Spanish/English (United States) (6x10)
PODD 15+ Preschool (3x5)
PODD 15+ School (3x5)
PODD 15 Preschool (3x5)
PODD 15 School (3x5)
PODD 60 Complex Syntax (6x10)
PODD 60 Expanded Key Word (6x10)
Text (7x10)
Gateway Text
Gateway 3x3
Gateway 4x3
Gateway 6x5
Other
LAMP Words for Life Layout Name
*
Please Select
LAMP WFL 1-Hit
LAMP WFL Full
LAMP WFL Transition
LAMP WFL - French/English 1-Hit
LAMP WFL - French/English Full
LAMP WFL - Spanish/English 1-Hit
LAMP WFL - Spanish/English Full
Other
Proloquo2Go Sub-Category and Layout Name
*
Please Select
Basic Communication 3x5
Basic Communication 3x6
Basic Communication 3x8
Basic Communication 4x8
Basic Communication 5x9
Intermediate Core 5x9
Intermediate Core 6x10
Intermediate Core 7x11
Advanced Core 3x5
Advanced Core 3x6
Advanced Core 3x8
Advanced Core 4x8
Advanced Core 5x9
Advanced Core 6x10
Advanced Core 7x11
Other
Keyguard Preview
Would you like the keyguard as shown or would you like to make alterations?
*
Looks Good! Please create that keyguard.
I would like to make changes.
Please Note- By Acknowledging,you understand that ableCARE will not be in contact with you and your keyguard will be automatically shipped out.
*
I Acknowledge
File Name (old)
Please Select
3x5
3x6
3x8
4x8
5x9
6x10
7x11
8x12
8x14
8x16
9x16
3x4
5x5
7x7
8x10
PODD 15
PODD 60
5x8
9x11
3x3
4x5
5x6
Text 7x10
Aphasia 3x3
Aphasia 4x3
Aphasia 6x5
7x12
2x2
9x13
5x10
4x4
4x4 and 1x4
9x12
10x14
6x7
6x8
10x12
5x4
5x11
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?
*
Please Select
Yes
No
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