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  • Please tell us how you learned about the South Shore Autism Center.
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Intake Form

Our dedicated professionals are here to support you though the intake process

Initial Client and Insurance Information Form
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  • Personal Information

  • Date Format: MM slash DD slash YYYY
  • Primary Health Insurance Information

  • Date Format: MM slash DD slash YYYY
  • Seconday Health Insurance Information (if applicable)

  • Date Format: MM slash DD slash YYYY
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  • Referral Information

  • How did you hear about South Shore Autism Center? Please fill in the blank with who referred you or how you heard about us.

  • Description of Needs

  • Language and Communication Preferences

  • Services and Scheduling

    Note: Quincy center will not be open until the winter of 2021.
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