Clone of Neurodivergent Community Group 2025

Therapy Groups Registration Form

All groups are billed to insurance under CPT code 90853. Please check with your individual carrier to verify coverage. We also offer private pay rates to those who do not want to utilize insurance.
If you are registering for someone who is NOT currently a client at Avenues for Autism, please complete the intake form BEFORE submitting this group registration form. The intake form can be found at: https://avenuesforautism.clientsecure.me/contact-widget
Location:

All groups are Virtual. Zoom link will be sent once registration is confirmed.
Please select the group that you are registering for:
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Fall 2026 Virtual Cooking Group
Offered to ages 15+ (younger on a case-by-case basis) on Tuesdays from 5pm-6pm

Free

Fall 2026 Navigating Adulthood
Offered to adults ages 25-45 years on Tuesdays (biweekly starting Tuesday, 9/15) from 5:30pm-6:30pm

Free
Participant's Full Legal Name:

First NameLast Name
Date of Birth:

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Funding source for group:
Is the participant a current counseling client at Avenues for Autism?

Registering for Services

If you are registering for someone who is NOT currently a client at Avenues for Autism, please complete the intake form BEFORE submitting this group registration form.
The intake form can be found at: https://avenuesforautism.clientsecure.me/contact-widget
Have you completed the new client intake form?

Name of person completing this form:

First NameLast Name
How did you learn about our group offerings?

Other
Please provide any additional information here. We look forward to speaking with you.
Should be Empty:

Therapy Groups Registration Form