Inquiry Form

Parent/Caregiver Name *

First

Last

Street Address *

Street Address Line 2

City

State

Zip *

Email *

Phone *

Child's Name *

First

Last

Child's Date of Birth *

Child's Current School *

Child's Grade *

School services are

Current Health Insurance *

Has your child received a formal medical diagnosis for autism spectrum disorder?

Tour our Treatment Center

How did you hear about us? *

Doctor or Office name *

Referrer Name

Other

Additional Comments

Website

A new kind of Center, A new kind of Hope

Administration

Phone (559) 492-7900

Fax: (559) 570-0222

Central Fresno

Phone (559) 475-7860

West Fresno

Phone (559) 724-3702

Merced

1160 W Olive Ave Suite C/E Merced, CA 95348

Phone (209) 205-9586

Footer Navigation