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ASD in Tennessee Intake Form
1.
Please enter your child's name, DOB and diagnosis.
2.
What therapies is your child currently enrolled in, or have done in the past?
3.
Does your child have an IEP?
Yes
No
4.
What are your biggest concerns regarding your child's diagnosis?
5.
On a scale of 1-10, what level is your anxiety regarding your child's diagnosis?