Take the first step today to getting answers Autism Assessment Self Referral Form Self Refferal Form Refer for an autism assessment, either for yourself or your child by completing the form below. One of our friendly, professional team will be in touch within 48 hrs. Alternatively, you can call us on 01302 630444. Enquiry type I would like to book an autism assessment I would like to speak to a member of the clinical team to discuss an autism assessment other Your Name(Required) First Last Email(Required) Phone Number(Required) Preferred contact method(Required)PhoneEmailPreferred contact time(Required) Weekday daytime Weekday evening Weekend day time No preference Postcode(Required) Autism assessment process and cost Information about the assessment process and cost for children can be found here Information about the assessment process and cost for adults can be found here Please Tick Below(Required) I confirm that I am aware of the cost for an autism assessment Who is this assessment for?(Required) Myself Someone under the age of 18 Someone under the age of 4 We cannot accept self-referrals from people under the age of 18.Age (in years) of person being assessed?(Required)Please enter a number from 1 to 120.Reason for Self-referral for Autism Assessment or other enquiry(Required)Have you / they been through the assessment process before?(Required) Yes No When did this assessment take place(Required) DD slash MM slash YYYY What was the result of this assessmentCAPTCHA Δ