INTAKE FORM - MINOR

Thank you for your interest in All 4 Autism! 
 
This intake form is to be completed by the caregiver of a minor, or caregiver that has guardianship of an adult. 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.
 
If you request a consultation, you will receive a confirmation email of the date and time. Our consultations are done by phone, unless another method is specified.
 
For information and upcoming events:
www.all4autism.org
https://www.facebook.com/autismresourcecenterofthepeedee/
 
We are so glad you reached out to us. Remember.. You are not alone!

Parent/Caregiver Information:

Minor/Dependent Information:

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