Referral Forms for Adult Client (age 18 and older) who is NOT his/her OWN GUARDIAN

Choose between two sections: 
Diagnostic Services (seeking diagnosis) or Intervention Services (have confirmed diagnosis).

Referral for DIAGNOSTIC SERVICES for Adult Client who is NOT own guardian

Families who are seeking diagnostic testing, for their adult child from the Wilmington TEACCH® Center must complete the History Form and obtain a Professional Referral Form.  Click on the links below to download the forms. Please note these forms can be completed and saved on the computer.

  1. History Form for Adult Client completed by the parents/guardians of the Adult Client
  2. Adult Professional Referral completed by a qualified professional who has knowledge of the client and an understanding of what ASD symptoms are present.
  3. Any other previous diagnostic and/or cognitive evaluation reports as indicated on the History Form must be submitted.
  4. Research Forms - Please review these forms and brochure before your clinic visit so that you can be informed about our research at TEACCH. You may sign and return them before or during your visit. You are NOT required to participate in research to receive TEACCH services
  5. Release of Information Form - If you wish to be able to communicate by email with TEACCH Staff at any point, you must complete and submit this form. spanish version

If you have any questions regarding the requested paperwork or the referral process, please call Kay Sanderlin at (910) 251-5700 or email kay_sanderlin@med.unc.edu

Please send completed paperwork and a copy of client's insurance card to the following address or fax to the number below:

Wilmington TEACCH Center
503 Covil Avenue, Suite 100, Wilmington, NC 28403

or Fax: 910-251-5809


Referral for INTERVENTION SERVICES for Adult Client who is NOT own guardian

Families who are seeking services from the Wilmington TEACCH Center for an adult who already has a documented diagnosis of Autism Spectrum Disorder must only complete the History Form.  Click on the link below to download the form. Please note these forms can be completed and saved on the computer.

  1. History Form for Adult Client completed by the parents/guardians of the Adult Client
  2. Diagnostic report confirming the diagnosis of Autism Spectrum Disorder must be submitted.
  3. Any other previous diagnostic and/or cognitive evaluation reports as indicated on the History form, must also be submitted.
  4. Research Forms - Please review these forms and brochure before your clinic visit so that you can be informed about our research at TEACCH. You may sign and return them before or during your visit. You are NOT required to participate in research to receive TEACCH services.
  5. Release of Information Form - If you wish to be able to communicate by email with TEACCH Staff at any point, you must complete and submit this form. spanish version

If you have any questions regarding the requested paperwork or the referral process, please call Kay Sanderlin at (910) 251-5700 or email kay_sanderlin@med.unc.edu

Please send completed paperwork and a copy of client's insurance card to the following address or fax to the number below:

Wilmington TEACCH Center
503 Covil Avenue, Suite 100, Wilmington, NC 28403

or Fax: 910-251-5809