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Caregiver Sign-up Form

Your voice matters! By simply providing your name and email address, you can join a community of caregivers dedicated to improving access to care for children with autism. The effort on your part is small—just a few seconds to sign up—but the impact of your participation could be enormous.


Once we get your contact information, we will send out a quick 30 second survey to better understand the challenges you and your family faced getting diagnosis or therapy services for your child with autism. The ONLY required fields are your zip code and email address, the rest of the information is voluntary - but the more information we have, the more we can help!.


We will also keep you informed with important updates, and from time to time we’ll ask for your insights and feedback. Your experiences and opinions will help shape the future of care for countless families across Kentucky.


Together, we can create meaningful change. Join our mailing list today and be a part of something powerful.

Your contact information

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