Autism/ABA/RDI® Intake Forms

If you are new to Family Guidance and Therapy Center you will need to fill out the following forms. Please fill the forms out to the best of your ability. Many of the form fields are required and you will not be able to submit the form at the end without each of these being filled out (required fields are marked with a red asterisk).

The intake form process consists of 5 pages and could take up to 30 minutes to complete so please make sure you have plenty of time before you begin.

For the Release of Information Form, please complete as many releases as you feel are relevant. For example, a release of information for all current providers (psychiatrist, therapist, school, etc) or previous providers. A release of information is needed for anyone that does not have legal custody of your child. If you have questions about who to complete the Release of Information form for, please contact the FGTC office. To submit multiple releases, please go here after you complete the intake forms below.

All forms are HIPAA compliant and secure. However, in order to maintain compliance with HIPAA and keep your information safe, you can not save your forms and finish them later. Please go through all the forms and make sure you click 'Submit' at the end to turn them into the FGTC office.

Please make sure you have the following information ready to upload:

  • Insurance card/information
  • Your child’s autism diagnosis report (or information of your diagnosing doctor to sign a release of information)
Sign the COVID Waiver

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