Autism Evaluation - Tell Us About Your Child

To make sure we are scheduling the appropriate appointment and testing, please send us a little information about your child you would like tested.

Parent Name

First Name

Last Name

Child's Name

First Name

Last Name

Child's Age

Email

Phone

(###)

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Has your child ever been evaluated for autism?

Tell us a little about your child and how we can help you?

List current diagnoses, any evaluations completed, and what are the main reasons you are seeking testing.