Please provide the following contact information for the person with Asperger's:

First Name
Last Name
Middle Initial
Date of Birth
Sex	Male Female
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
*Parent Name
Work Phone
Home Phone
*Parent E-mail

*If applicable

 

please contact me through email only

Here is my E-mail

Choose one or more of the following:

Social Skills Group

Individual Therapy

IEP Support

Workshops

Social Motivation/General Reciprocity September 6 thru October 1, 2008

Bossing People Around/Socially Appropriate Noncompliance October 
        18 thru November 22, 2008

                      
Negotiation/Reading an Authority Figure's Level of Desire January 10 thru February 14, 2009

Faking Emotions/Recognizing and Using Rhetoric February 21 thru March 28, 2009

Select any of the following payment methods that apply:

INSURANCE                                               

COUNTY WAIVER (EXCEPT WAUKESHA COUNTY)                        
COUNTY FAMILY SUPPORT                                   
PRIVATE PAYMENT