This field is hidden when viewing the form

Next Steps: Sync an Email Add-On

To get the most out of your form, we suggest that you sync this form with an email add-on. To learn more about your email add-on options, visit the following page (https://www.gravityforms.com/the-8-best-email-plugins-for-wordpress-in-2020/). Important: Delete this tip before you publish the form.

About You

Your Name(Required)

First Last

What pronouns do you prefer?

He/Him

She/Her

They/Them

Please describe your goals for coming in today for an evaluation(Required)

What specific Autism symptoms would you like us to know about?(Required)

What was your score on the Autism Quotient?(Required)

What, if any, additional symptoms would you us to know about you?

Please check any of the following you have experienced in the past six months(Required)

How do your symptoms impact home or work?(Required)

Have you seen a mental health professional before? If so, how did you feel about it?

Is there a history of Autism, ADHD or mental health issues in your family?(Required)

Do you have any medical conditions?(Required)

Intake

Next Steps: Sync an Email Add-On

About You

Related Posts