KAS Group Interest Form
KaleidAScope, Inc. provides quality clinical services to individuals with autism spectrum disorder and their families in Erie and Crawford counties. We are currently assessing interest and need for clinical programming - specifically clinical groups to help support individuals with ASD develop and maintain skills. We are also looking for interest in support groups that could be made available to individuals supporting those with ASD.
Please complete the first portions of this form to indicate what types of groups could be beneficial to you and those that you support.
If you are interested in receiving direct contact when groups are developed/scheduled - make sure you fill out the second portion of the form.
If you have any questions - please contact the KaleidAScope, Inc. office at (814) 824-4515.
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What age range would you be looking for when it comes to groups? (select all that apply)
What type of group format would you be interested in?
If private pay groups were offered (groups that would not be covered by insurance and would need to be paid for "out of pocket") - is that something you would consider?
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GROUP FOCUS - Review the different types of groups and mark any that you think would be of interest/beneficial to you or the person with ASD that you are thinking about. 
What other offerings/classes/opportunities do you think would be beneficial to individuals with ASD and their families?
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