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0477-778-414
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Our team is here to help you with any questions or needs you have. If you would like to speak with one of our clinicians, please feel free to either call, email, or complete the form below, and our team will be happy to answer any questions you have, and schedule a free consultation.
General Information
Parent/Guardian First Name
*
Parent/Guardian Last Name
*
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*
State/Province/Region
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Detroit, MI
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Melbourne, Vic
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Adelaide, SA
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Milwaukee, WI
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*
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Boise, ID
Zip Code / Postal Code
*
Phone Number (US and Canada)
*
Phone Number (Australia)
*
Email
*
Insurance Type
*
Insurance Type
Private Insurance
Medicaid
Self-Pay
Child's Age Range
*
Please select from the drop down menu.
0-2
3-4
5-8
9-12
13+
Daily Availability for Services
Monday
*
All Day
8am-Noon
Noon-3pm
3pm-7pm
Not Available
Tuesday
*
All Day
8am-Noon
Noon-3pm
3pm-7pm
Not Available
Wednesday
*
All Day
8am-Noon
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3pm-7pm
Not Available
Thursday
*
All Day
8am-Noon
Noon-3pm
3pm-7pm
Not Available
Friday
*
All Day
8am-Noon
Noon-3pm
3pm-7pm
Not Available
Saturday
*
All Day
8am-Noon
Noon-5pm
Not Available
Additional Availability Information
How did you hear about EAS?
*
Please select from the drop down menu.
Doctor Referral
Insurance Referral
Outside Provider (Speech, OT, PT)
School/Daycare Provider
Google
Facebook
Community Event
Walk/Run
Friend/Family Member
Other
How did you hear about EAS? (Other)
Initial Intake ID
Email
This field is for validation purposes and should be left unchanged.
Home
About Us
Our Services
In-Home ABA Therapy
Center-Based ABA Therapy
Telehealth Services
Social Skills Groups
Teens & Adolescents
Programs
Behaviour Therapy
Fine & Gross Motor Skills
Language & Communication
Play
Pre-academic Skills
Self-Help
Social Skills
Resources for Parents
Autism FAQs
Getting Started
EAS Blog & Videos
Resource Directory
Research & Helpful Resources
Our Locations
United States
Alabama
Georgia
Idaho
Indiana
Illinois
Chicago
St. Louis
Maryland
Massachusetts
Michigan
Detroit
Ann Arbor
Grand Rapids
Kalamazoo
Lansing
Missouri
New Jersey
Oregon
Portland
Salem
Pennsylvania
Tennessee
Virginia
Alexandria
Richmond
Australia
Victoria
India
Karnakata
Careers
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