All Hands In

This referral form allows you to share general concerns only so our team can follow up directly with the family.  Please do not include detailed medical records or sensitive health information on this form, this will be collected later through HIPAA secure means. 

Once submitted, we will contact the family within 1–2 business days to discuss next steps.

This referral form is appropriate for: 

• Autism or developmental concerns
• ADHD or attenttion concerns
• Behavioral or emoitonal regulation challenges
• Functional labs or gut health
• FES-UA Families
• School or Learning concerns
• Any concerns for developmental delays