Synergy Autism - Wait List
Hello. Thank you for your interest in services. I would love to meet with you and hear more about your needs however, I am currently very busy serving many other lovely individuals, teams and families. I ask that you fill out this online form to be added to my wait list. The form asks questions about your needs and I will review entries as soon as I am able to respond. Should you have any other questions, please contact me at
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Email *
Your name *
How did you hear about my services? *
It may be a longer wait time for clients accessing services through the county DD program or other agency. I can only take a certain number of you at a time. How are you planning to access services? (I do not take insurance). *
Type of support you are seeking *
Age of the person with autism or suspected of having autism in your life (your age, if you are wishing for services for you) *
What are you hoping for from my services? *
What type of service are you interested in?
Would you like to be added to my e-newsletter? *
A copy of your responses will be emailed to the address you provided.
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