Clone of 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.Format: (000) 000-0000.
Parent / Guardian Email*
example@example.com
Optional SMS Updates from KBH. You may choose to receive non‑marketing SMS text messages from Kind Behavioral Health (KBH), including intake confirmations, scheduling updates, appointment reminders, and support replies. Message frequency varies. Standard msg & data rates may apply. Reply STOP to unsubscribe or HELP for help. SMS participation is optional and not required to receive services. You may receive all communications by email or phone instead.

I agree to receive SMS text messages from KBH.I do NOT agree to receive SMS text messages from KBH.
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: