All 4 Autism Intake Form

Thank you for your interest in All 4 Autism.
 
Your input helps us locate services and support in our area that you are seeking. Please provide as much information and detail as possible, so that we will have the background we need to find appropriate resources. The more information we have, the more help we can provide.

Parent/Caregiver Information:

Child's Information:

Thank you for taking the time to complete the intake form. We are so glad you reached out to us, and hope to provide you with the support and resources that you need.
 
For information on various agencies and organizations that provide services for Autism Spectrum Disorder, please go to our RESOURCE GUIDE here:
The mission of All 4 Autism is to provide support and resources to ALL those affected by autism, in the Pee Dee Region. We are a grassroots organization, and all of our services are free and open to the public.

WANT TO HELP SUPPORT OUR EFFORTS? Please consider joining our ARC Angel Society.

For more information: https://all4autism.org/arc-angel-program-individuals