Synergy Autism - Wait List

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Hi, and thank you for reaching out to me. I may soon have some appointment slots opening up for a new client. Please add your information here if you would like to be considered.

It's worth noting that in order to provide the absolute best care that I can, available spots to work with me are limited. Getting on my wait list doesn't guarantee you'll get an appointment and, if you find that you are waiting a long time, I recommend contacting The Autism Society of Oregon for referrals that may best match your needs.

Info@autismsocietyoregon.org

I'm wishing you all the best,

Thank you

Email *

Your name
*

Type of support you are seeking
*

Age of the person with autism or suspected of having autism in your life (your age, if you are wishing for services for you)
*

What are you hoping for from my services?
*

How did you hear about my services?
*

Option 1

Autistic teen or adult group

Individualized teen or adult coaching sessions

Parent/caregiver group

Personalized parent/caregiver training sessions

Other:

Would you like to be added to my e-newsletter? *

Yes

It may be a longer wait time for clients accessing services through the county DD program or other agency. I can only take a certain number of you at a time. How are you planning to access services? (I do not take insurance).
*

Privately

Other:

A copy of your responses will be emailed to the address you provided.

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