Getting Started

New Client Intake Form

Thank you for your interest in Guiding Little Steps ABA Therapy Services. Please complete the form below to help us learn more about your child and family. Once your form is submitted, a member of our team will contact you within one to two business days to discuss the next steps.

Step 1

Child Information

Gender

Step 2

Parent / Guardian Information

Parent / Guardian #1

Relationship to Child *
Preferred Method of Communication *

Parent / Guardian #2 (optional)

Relationship to Child
Preferred Method of Communication

Step 3

Insurance Information

How will services be paid for? *

Step 4

Autism Diagnosis

Has your child been diagnosed with Autism Spectrum Disorder (ASD)? *

Step 5

Current Services

Is your child currently receiving any of these services? *

Step 6

Behavior Concerns

Please select any concerns that apply: *

Step 7

Communication

How does your child primarily communicate? *

Step 8

Service Preferences

Which services are you interested in? *
Preferred Days *
Preferred Time *

Step 9

Additional Information

How Did You Hear About Us?