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Autism

  • Autism Questionnaire

    Please answer all questions applicable to the client's medical history.
    Questions? Call Jim or Teresa at 877.564.1707.

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






  • Date Format: MM slash DD slash YYYY


  • Click the + sign to add additional medications.
    Name of Medication (prescription or otherwise)Dates UsedQuantity TakenFrequency Taken 

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