ASD Diagnostic Evaluation Interest Form

ASD Diagnostic Evaluation

Interest Form
Kind Behavioral Health is dedicated to supporting families on their journey with Autism Spectrum Disorder (ASD). We understand how challenging it can be to access timely diagnostic evaluations and how important it is to receive clear answers and guidance.

To better support families, Kind offers in-house autism diagnostic evaluations as part of our integrated behavioral health model. This allows us to reduce delays and provide timely, evidence-based insight into a child’s development, along with clear next steps for care.

The form below is designed to help us understand your needs and guide you through the appropriate diagnostic pathway.

Please submit the basic information below, and our team will follow up with next steps to support your family.

Thank you!
Parent / Guardian Name*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState

Zip Code
Please select your City and State*
Parent / Guardian Phone Number
Please enter a valid phone number.
By providing the phone number above provides Kind Behavioral Health (KBH) consent to communicate with me via SMS text messaging and also agree to KBH's Policy and Procedures and Privacy Policy. Message frequency will vary. Message and data rates may apply and carriers are not liable for delayed or undelivered message. Reply STOP to cancel messaging. Reply HELP for assistance.

I agree to communicate with KBH via SMS messagingI do not agree to communicate with KBH via SMS messaging
Parent / Guardian Email*
example@example.com
Child's Name*

First NameLast Name
Child's Date of Birth*

MonthDayYear
Child's Home Address*

Street Address

Street Address Line 2

CityState

Zip Code
What is your relationship to the child?
What type of ASD Diagnostic Evaluation appointment is preferred?

In-person evalution (NC only)Virtual (Telehealth) evaluation
Closest Kind Behavioral Health clinic location*
How did you hear about KBH?
Age
Today

MonthDayYear
Date
Should be Empty: