About you

May we leave a message?
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Preferred contact method
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About your child

If you have more than 1 child in need please list all here separated by a comma

Have any of your children in need been diagnosed with ASD or related diagnosis?

Your Family’s Needs

What are your child’s greatest areas of need?

When thinking about your child’s treatment and education, what is most important to you?

When thinking about your child’s future, what is most important to you?

Treatment Considerations

How did you learn of FirstSteps?

Treatment Services of Interest
---Individual 1:1 InterventionGroup LearningTargeted TreatmentTelehealth

Our program is based on scientific research which consistently indicates that best child-outcomes are achieved when ABA treatment is delivered in early childhood, and intensively (25+ hours per week), with parents included and active in

Is at least one caregiver willing and able to participate in your child’s treatment program?
YesNoUnsure

Is your child able to receive a high level of weekly treatment hours as determined via individualized assessment?
YesNoUnsure

Care Team

Does your child have an IEP (if yes, write in School District and school attending)?

Are you working with your local Regional Center (if yes, write in Regional Center you are working with)?

Health Insurance Carrier

Does your plan include ABA Benefits for the treatment of ASD?
YesNoUnsure

Any other overall comments or info we should know about (optional)