Intake_With You ABA Centre
Thank you for reaching out to With You ABA Centre! 
Please answer the following questions for the BC's information before following up on any inquiry. You can answer in your comfortable language!
BC will reach out to you either via email or phone call within 3 business days regarding the service availability to discuss the future plan. 
I appreciate your time.

문의주셔서 감사합니다!
문의에 대해 응답해드리기 전, BC 선생님의 정보를 위해 아래 정보를 작성 및 제출해주시면 감사하겠습니다. 편하신 언어로 작성해주시면 됩니다.
작성해주신 정보를 바탕으로 BC선생님이 영업일 3일 내 이메일 또는 전화로 연락드릴 예정입니다. 
이 때 서비스 가능 여부와 추후 계획 등을 논의드리도록 하겠습니다. 
감사합니다.
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Please write your child's name. *
Please tell us the date of your child's birth *
MM
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DD
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YYYY
Please write your name(caregiver's name) for us to reach out to. *
What's the email address you would like to receive the email? *
What's the contact number that can connect to you? *
Please describe what are your(or school's) concerns with your child. Please be specific as much as possible. (You can type in your comfortable language.) *
Which services are you interested in? *
Required
With You ABA Centre does not provide any home-based service. Do you agree to travel to the centre? *
Will you use the Autism Funding? *
Has your child received any intervention(BC/BI, SLP, OT, etc.) before? If he/she has, please explain to us when and how long has it been. *
If you are wishing to switch the BC, please explain the reason why you are terminating with the current BC. *
What are the good time for BC to reach out for a phone call?  *
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