MTSN Intake Form

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MTSN Intake Form

Email *

With which condition has your child been diagnosed? Select all that apply. *

Autism Spectrum Disorder

Asperger’s Syndrome

Speech Delay

Echolalia

Non-Verbal/Selective Mutism

Other:

Required

Has your child previously received therapy for these conditions? *

Yes

If yes, which type of therapy has your child received? Select all that apply. *

Speech Pathologist

Psychologist

Family Therapist

ASL Teacher

ABA Therapist

Occupational Therapy

Other:

Required

Were you an active participant in your child’s therapy? *

Yes, I sat in on or observed sessions.

No, I was not able to sit and observe sessions.

What were your take-aways from your child’s previous experience with therapy? *

Are you willing to take the strategies provided here and practice them in your home? *

Yes

Maybe

Please describe your expectations for this course for you and your family? *

Submit

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