Medical or Educational Referral for Family Autism Navigation

Mar 11

The Arc of Tri-Cities offers Autism navigation services for families whose child has a new diagnosis of Autism. We help with support and help navigating the local, state and federal resources and services. There is no charge to families for Parent to Parent support and services.

This referral system is for clinicians who feel that their client would benefit from the support and guidance of Parent to Parent Coordinator Melissa Brooks RN, and would benefit from being connected to the system of support that Parent to Parent offers.

Name of Child

First Name

Last Name

Name of Parent of Child

First Name

Last Name

Phone of Parent to Contact

(###)

###

####

Is this a texting number

Yes

Unsure

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent's Email

Language of Family

Date of Birth

Insurance

No insurance required for Parent to Parent Services, information used to help apply for therapies and services only.

First Name

Last Name

Name of Referring Clinician

First Name

Last Name

Name of Referring Agency/Office/School

First Name

Last Name

Email of Clinicain or Contact person

Phone of Clinician or Contact Person

(###)

###

####

Donna Tracy

Medical or Educational Referral for Family Autism Navigation

The Arc of Tri-Cities

Hours

Mission Statement:

Medical or Educational Referral for Family Autism Navigation

Parent to Parent

Multi-Cultural Outreach

The Arc of Tri-Cities

Hours

Mission Statement: