Contact Contact Us We are here to help. CONTACT US Whether you’re ready to start services, interested in a job, or just have a question, we’d love to chat. How can we help you today?*Services for my ChildInterested in a CareerMake a ReferralOtherName* First Last Child's Name* First Last Email* Phone*City* County*Adams CountyAllen CountyBartholomew CountyBenton CountyBlackford CountyBoone CountyBrown CountyCarroll CountyCass CountyClark CountyClay CountyClinton CountyCrawford CountyDaviess CountyDearborn CountyDecatur CountyDeKalb CountyDelaware CountyDubois CountyElkhart CountyFayette CountyFloyd CountyFountain CountyFranklin CountyFulton CountyGibson CountyGrant CountyGreene CountyHamilton CountyHancock CountyHarrison CountyHendricks CountyHenry CountyHoward CountyHuntington CountyJackson CountyJasper CountyJay CountyJefferson CountyJennings CountyJohnson CountyKnox CountyKosciusko CountyLaGrange CountyLake CountyLaPorte CountyLawrence CountyMadison CountyMarion CountyMarshall CountyMartin CountyMiami CountyMonroe CountyMontgomery CountyMorgan CountyNewton CountyNoble CountyOhio CountyOrange CountyOwen CountyParke CountyPerry CountyPike CountyPorter CountyPosey CountyPulaski CountyPutnam CountyRandolph CountyRipley CountyRush CountyScott CountyShelby CountySpencer CountySt. Joseph CountyStarke CountySteuben CountySullivan CountySwitzerland CountyTippecanoe CountyTipton CountyUnion CountyVanderburgh CountyVermillion CountyVigo CountyWabash CountyWarren CountyWarrick CountyWashington CountyWayne CountyWells CountyWhite CountyWhitley CountyAge of Child*Please select the following conditions for which your child has an official diagnosis.*Choose all that apply ASD ADHD Intellectual Disability N/A – My child needs a diagnostic evaluation What type of school/daycare program is your child enrolled?*Full DayPartial dayNot enrolled in school/daycareWe accept most forms of health insurance and Medicaid. Please select which type(s) of insurance coverage you have.*Choose all that apply BlueCross BlueShield Indiana Medicaid United Health Aetna UMR Cigna Other If other, please list:* What best describes you?*PediatricianDiagnosticianDaycare/SchoolService Provider (case manager, counselor, etc.)Advocacy GroupPayor/FunderOtherIf other, please list:* Message*CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.
