Please complete this brief pre-screening form so our team can review basic information and determine possible next steps.
This form helps us understand:
- Basic contact information
- Child’s age and location
- Insurance provider
- Current daytime schedule
- Preferred program schedule
- Primary support need
- Prior services, if applicable
Our standard program options are:
- Monday through Thursday, 10:00 AM to 2:00 PM
- Monday through Thursday, 3:30 PM to 7:00 PM
- Monday through Friday, 9:00 AM to 3:00 PM.
Submitting this form does not guarantee enrollment, services, or a client-provider relationship. If the information appears to be a possible fit, our team may invite you to complete the full Service Request form.
Services cannot begin until all intake requirements, clinical reviews, and any needed insurance authorizations have been completed.
