Request a SpEdCare Account

Please complete the form below. All provider licenses, credentials and certifications are verified prior to approval for school-based service recording. If you need further assistance you can email us at lea@practi-cal.com




Please enter your first name as it appears on your license or credentialing.


Please enter your middle name or Initial.


Please enter your last name as it appears on your license or credentialing.


(Optional) If you have a last name different from the one listed on your license, credential or certification (married name, maiden name....etc) that you would like to be used for your SpEdCare account, please enter it here.




Please select your practitioner type. If not listed add to the comment section below.


If available, enter the document number associated with the practitioner type listed above


If available, select the issue date associated the license or certificate.


If available, select the expiration date associated the license or certificate.



If you checked "Contracted" and work for an agency, please list the name of the agency in the field below.




(Optional) if you have an electronic copy of your license, credential or certification, you can upload it here.


Enter any additional comments below. If your practitioner type was not listed above, you can enter it here.


Powered by Smartsheet Forms
Privacy Policy   |   Report Abuse
Your submission is being processed. Please do not close this browser window until complete.