Getting started

Client intake

Share a few details about your child and family so we can prepare for your first conversation. It takes about 10 minutes. Fields marked * are required, and everything you send stays confidential with our team.

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Parent or guardian

Full name * Relationship to child * Email * Phone * Home address City ZIP code Best way to reach youPhone callText messageEmail Best time to reach youAny timeMorningAfternoonEvening

About your child

Child’s full name * Date of birth * Preferred name Primary language at home DiagnosisAutism spectrum disorder (ASD)Diagnosis in progress / awaiting evaluationOther diagnosisNo diagnosis Diagnosed by (provider) and date Current school or daycare Grade or program Does your child have an IEP, 504 plan or other current therapies? (speech, OT, ABA, etc.)

Insurance

Payment typePrivate insuranceMedicaid / Health First ColoradoTRICAREPrivate payNot sure yet Insurance provider Member ID Policy holder name

I confirm this information is accurate and agree to be contacted by Atlas about services. * Submit intake