We’re Here to Help

Complete our comprehensive questionnaire to begin your child's personalized autism treatment journey. Help us understand your child's needs and medical history.

1. Demographic Information

Child:
Parent or guardian:

2. Diagnosis and Medical Conditions

Has your child been diagnosed with Autism Spectrum Disorder (ASD)?
Symptoms:
Has your child experienced digestive symptoms?
Select the behavioral challenges you’ve observed

3. Previous Treatments

4. Current Use of Medications

Is your child currently taking any medications?
Immunosuppressants:
Is your child taking any immunosuppressive medications or steroids?

5. Travel Information

6. Treatment Expectations and Understanding

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