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Request For Services

To find out more information about our services, please fill out the form below or call us at 310.320.5856. 

We will then call you to schedule an intake interview. You may be asked to provide your child’s most recent psychological/medical evaluations.  These reports should present a description of your child’s developmental history, your child’s diagnosis, and a description of your child’s current levels of functioning.

Please allow up to 3 business days to review these materials once they are received.

Parent/Guardian name:
Child's name:
Child's DOB:
Address 1:
Address 2:
City:
State:
Zip Code:
Email:
Phone:
Diagnosis:
 
Type of Service being requested:
Local-area Supervision
Workshop Consultation



 


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Contact Information

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E-mail:

 

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Resources in Autism Education
1223 El Prado Ave. Torrance, CA 90501
Phone: 310.320.5856      FAX:  310.320.5818

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