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Purple Podiums

Client Initial Intake Form

Our Client Initial Intake Form is designed to make sure we have accurate and up-to-date information about our clients. Each form is tailored to the individual's needs and provides us with valuable information that will help us better understand our clients and provide them with the best possible service.

We ask that each client fill out the form to the best of their knowledge and truthfully. This way, we can ensure that the form is accurate and we can provide the best services to our clients. Thank you for taking the time to fill out the form.

Does the applicant or person whom you are seeking seeking services for have a diagnosis of Autism?
Does the applicant or the person seeking services have any other health conditons?
What type of assistance are you seeking?

We have received your request and will get back to you within 24-48 hours. Thank you for reaching out to An Autastic Dream Inc. Together we can bring an autastic dream to life.

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