Is this your first time applying for our help?
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Yes. This is my first time applying.
No. I've applied before and missed my call.
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Your First Name
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Your Last Name
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Your best email address
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example@example.com
Your phone number
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Please provide a phone number in case we need to reach out to you for clarification about your application.
Format: (000) 000-0000.
Where do you live? (city, state, country if outside the US)
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Does your child have autism?
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Yes
No
I'm not sure
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Is your child a boy or girl?
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Boy
Girl
Your child's age
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Your child's name
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What's your #1 challenge with your child right now?
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Which areas do you need the most help with?
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I’m new to autism and don’t know what to do to help my child
I feel like I can do more to help my child, but am not sure what
Behavior / Anxiety
Behavior / Aggression
Focus / Attention
Gut health/nutrient absorption (constipation, diarrhea, belly pushing or pain, not gaining weight or muscle)
Picky eating
Poor sleep
Sensory issues
Special diet / Food sensitivities
Speech / Communication issues
All of the above
Other
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What have you tried or invested in that did and didn't work?
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How has autism impacted your, your child's, your families life? (please be specific)
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Why not just keep doing what you're currently doing to solve this?
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How confident are you in your current plan?
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Very confident... I don't really need help. I'm just curious.
Somewhat... I need help figuring out what's missing.
Not at all... I need help and I'm not sure what to do.
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How much would you be willing to invest in a solution that works for you? Please be as accurate as possible here.
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Don't have the finances now but maybe in the future.
$200 to $1,000 - As much as a nice TV or furniture.
$1,000 to $3,500 - As much as a nice vacation.
$3,500 to $7,000 - As much as a bathroom upgrade.
I will invest what it takes to help shift my child’s autism behaviors and life.
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As we review your application, could you please tell us why you think you'd be a good fit for our help?
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Almost done. Two easy questions left.
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How did you hear about Autism Transformed?
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If referred by your physician or specific health practitioner/resource, please let us know their name above.
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If your application is approved and we both determine our help on your journey for your child becoming more calm, connected and communicative is a mutual fit… will you be friendly and coachable?
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Yes. Absolutely.
No
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