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Programs
Adolescent
Adult Autism
Elementary
Preschool
Autism Services For Kids With Autism
Parents
COVID-19 Information
Calendar
Bus Schedules
Parent Resources
Scientific Findings
Pingree PTA
About Us
Blog
Do Your Blue
Get Involved
In The News
Meet The Team
Our Facility
Resources
Success Stories
Join Our Team
Contact
Commercial Insurance
Pingree Center Referral Form
Donate
Pingree Center Referral Form
Pingree Center Referral Form
Parent/Guardian Full Name
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Parent/Guardian Email
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Child's Full Name
Child's Date of Birth
MM slash DD slash YYYY
Insurance
Does child have a previous diagnosis of Autism (Yes/No)
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Please list any additional diagnoses your child has (e.g. ADHD, Anxiety etc.)
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