Scheduling Site Visits Form
Thank you for your interest in scheduling a site visit with Reach Out & Read Illinois, currently we are only accepting visits in a virtual format. If this does not work for you, please feel free to reach out to us via email (oheinzeroth@illinoisaap.com).
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Clinic Site Name
*
If you are requesting a visit for multiple site locations, please submit a separate form for each site.
Clinic Site ID
This number can be found in your myROR.org portal. If you are unsure, please sign in to myROR.org.
Date Option #1 - Priority Choice
*
/
Month
/
Day
Year
Please select a date between October and December 2026. Site visits should take 45 minutes, but we will schedule for a full hour in case more time is needed.
Date Option #2 - Second Choice
*
/
Month
/
Day
Year
Please select a date between October and December 2026. Site visits should take 45 minutes, but we will schedule for a full hour in case more time is needed.
Date Option #2 - Third Choice
*
/
Month
/
Day
Year
Please select a date between October and December 2026. Site visits should take 45 minutes, but we will schedule for a full hour in case more time is needed.
Time of Day
*
Morning (9 am - 11 am)
Lunch Hour (12 pm - 1 pm)
Afternoon (2 pm - 3 pm)
Please note, we are currently only scheduling site visits in a virtual format. We are able to conduct these calls in either Zoom or Teams, select which option you prefer.
*
Zoom Video Call
Teams Video Call
Should anyone else be informed about this meeting? Please include their first and last name, email address, and role within the clinic.
*
Consider your supervisor or any relevant site staff. If you do not have anyone to include, please type "N/A"
Submit
Should be Empty: