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* Indicates required question
Email
*
Your email
Your Name
*
Your answer
Does your child have a diagnosis?
*
Choose
Yes
No
What is the diagnosis? (If you selected no, please use N/A)
*
Your answer
Child's Age
*
Your answer
Race and Ethnicity (Select all that apply)
*
African American
Asian
Native American/Native Hawaiian
White
Middle Eastern or North African descent
Hispanic/Latino
Other:
Required
Are You Currently Receiving Therapy Support
*
Choose
Yes
No
Are you in need of therapy or support group
*
Choose
Therapy
Support Group
Both
Are you a participant in the
SPARK
autism research study?
*
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Yes
No
Don't know / Prefer not to answer
Zip Code
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Your answer
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