Initial Intake Form
If you have a specific need, question, or concern and would like to be contacted by one of ASC's Autism Navigators, please fill out this initial intake form and you will be contacted by an Autism Navigator as soon as possible.

First Name:  (Required)
Last Name:  (Required)
Email:  (Required)

Name(s) and age(s) of individual(s) with autism  (Required)
County where person with autism resides  (Required)
Phone Number(s) and/or email(s)  (Required)
Best way to contact you  (Required)
Please describe the main issue(s) you face in regards to autism or the resources you need  (Required)

Any additional information you would like to provide