ADP Authorizer Submission Form Are you an ADP Authorizer and want to be listed on our website? No problem! Just complete the form below and watch your information get listed on our maps! ADP Authorizer FormPlease enable JavaScript in your browser to complete this form.Your Name *Category *ADP AuthorizerADP VendorBoth Authorizer and VendorProfession *Occupational TherapistPhysiotherapistNurse PractitionerOphthalmologistOptometristVision Rehabilitation WorkerSpecialist Teacher of the BlindRehabilitation TeacherCCTV Optical Enlargement Systems AuthorizerHigh Technology AuthorizerOrientation and Mobility InstructorDoctorOtolaryngologistAudiologistHearing Instrument PractitionerSpeech-Language PathologistMembers of Diabetes Education Program (DEP)An amputee team (Physician, a Physiotherapist or Occupational Therapist and a ProsthetistOtherADP Authorizer of: *MobilityHearingCommunication AidsVisual aidsDiabetic Equipment and SuppliesRespiratory Equipment and SuppliesHome Oxygen TherapyArtificial Eyes and Facial ProstheticsGarments, Pumps and BracesBreast Prostheses and Artificial LimbsEnteral Feeding and OstomyName of Business / Organization *Business Street Address (including number) *City *Postal Code *Phone Number(s) *EmailEmailConfirm EmailAdditional InformationWebsiteSEND MESSAGE