Autism G.E.A.R.S. Initial Client Intake Form
We are now offering insurance-covered ABA Therapy!

If you would like to be contacted by a member of our team to begin the intake process, please fill out the form below.

Disclaimer: Filling out this form does not guarantee we will offer services through Autism G.E.A.R.S., does not guarantee that your insurance company will cover costs of treatment, and does not constitute any legal contract between you, your insurance company, or Autism G.E.A.R.S.
  • Please enter the name of the person who will be receiving services
  • / /
  • Please enter details about individual's diagnosis
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    Please enter your best contact number
  • Please enter your e-mail address
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  • Please note any additional comments here
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