Full Name

Nationality
SaudiNo-Saudi

Date of Birth

Age

Gender
MaleFemale

Income
Social securityComprehensive rehabilitationSalaryNothing

Income amount

City

Neighborhood

Contact number

Type of disability

The program you would like to join
CommunicationEducationWorkThe elderly and Internet of thingsAccessibility

Ability to communicate
I can speak clearlyI communicate in a very weak voiceThere is no voice and communication by gestures or facial movementsCommunicate using specific devices and applicationsother

Level of perception
Perception is naturalI have forgetfulness and poor memoryI have learning difficultiesI have an intellectual disabilityother

Would you like to modify your home technically so that it becomes easier and easier to control lights and air conditioning electronically?
YesNo

Do you have a healthcare attendant?
YesNo

Are you a job seeker?
YesNo

After receiving the services provided by Tawasal Association, do you allow your registered data to be shared with recruitment companies?
YesNo

Do you allow media appearances (on media channels – social networking sites)?
YesNo

– The report provided to the beneficiary, which may refer to devices, stores, or websites selling assistive tools, is not the responsibility of the association regarding the availability or unavailability of items at the stores or service providers.

– The evaluation provided by the specialist is not a medical evaluation and cannot be relied upon to request medical care from other entities.

– The supervising doctor at the medical rehabilitation center must be informed of the techniques proposed by the specialist, and any contact information for the Tawasul Association must be provided.

– The beneficiary agrees and permits the specialist to modify or disassemble the chair or device in their possession if required by mutual agreement.

– There is no objection to photographing parts of my body (hand, foot, etc.) during the use of the service for evaluation, quality, and media documentation purposes, and using the recorded material, either visually or audibly, for educational and diagnostic objectives.

– The beneficiary is committed to attending the evaluation session after confirming and communicating effectively with the coordinators.

– If the beneficiary needs to cancel attendance, they must provide notice at least 48 hours before the scheduled session.

– The service fee paid is non-refundable if the appointment is canceled, and another appointment will be arranged that suits the beneficiary.

– To ensure the safety of the beneficiary, transferring the beneficiary from the chair, if necessary, is the responsibility of the companion or personal assistant, not the specialist.

Agree to the terms and conditions
I have read the terms and agree to them