Menu

Donate

Milestones Autism Resources

4853 Galaxy Parkway, Suite A
Warrensville Heights, OH 44128

Phone: (216) 464-7600

Home Submit an Intake Form Intake Form Family

Intake Form for Family Member / Friend

This form is to be completed by a parent, other family member or friend of an autistic individual to receive assistance.

Please note that by clicking submit you are agreeing to receive occasional correspondence from Milestones Autism Resources. We are currently reviewing our policy and are planning to revise it in the near future.

Si el español es su idioma principal, puede traducir este formulario (y este sitio web) al español haciendo clic en la palabra Español en la esquina superior derecha de la ventana de este sitio web.

Tenga en cuenta que al hacer clic en Enviar, acepta recibir correspondencia ocasional de Milestones Autism Resources. Actualmente estamos revisando nuestra política y planeamos revisarla en un futuro próximo.

Submit

Photo Gallery

1 of 22

Need assistance? Let Milestones be your local guide.

Unsure of where to start? Contact our free Helpdesk with your questions, and we will do the research for you!

Visit milestones.org/helpdesk and complete an intake form.