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INTAKE & REFERRALS

CONNECTING FAMILIES TO THE HELP THEY NEED

Making a referral to Harmony Autism Center is quick and easy. You can complete our secure online referral form anytime, or connect with our team directly to get started.

1

Complete the Intake Form

Fill out our secure online form with basic information about your child and your concerns.

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2

We Review Your Information

Our team will carefully review your intake form and contact you to gather any additional details.

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3

Schedule an Initial Meeting

We’ll meet with you in person, by phone, or online to discuss your child’s needs, answer your questions, and explain our services.

WHO CAN MAKE A REFERRAL?

Parents or guardians
Schools and educators
Pediatricians and healthcare providers
Social workers or case managers

READY TO GET STARTED?

Fill out our Intake & Referral Form and take the first step toward personalized care for your child.

CHILD RESIDES WITH
PARENTS
GUARDIANS
OTHER
PARENT IS AWARE OF THIS REFERRAL?
YES
NO
CURRENT CHALLENGES & CONCERNS
CHECK ALL THAT APPLY TO YOUR CHILD:
HOW DID YOU HEAR ABOUT US?
CHILD'S COMMUNICATION STYLE
PREFERRED CONTACT METHOD FOR FOLLOW-UP
PHONE
EMAIL
TEXT MESSAGE
EITHER PHONE OR EMAIL
BEST TIME TO CONTACT YOU
DOES YOUR CHILD HAS STRAIGHT MA?

CURRENT DIAGNOSIS

REQUIRED DOCUMENTS

To help us process your chilfi referral as quickly as possible. please upload the following documents.

REQUIRED

If Your Child Previously Received ABA or EIDBI Services

PLEASE UPLOAD THE FOLLOWING DOCUMENTS. IF AVAILABLE:

NEED HELP OBTAINING THESE RECORDS?

Multi choice

Please note: Your referral cannot move forward until all required documents have been received and your child's insurance has been verified.

Multi choice
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