Referral Forms for Adult Client (age 18 and older)

An adult who is seeking diagnostic testing from the Asheville TEACCH® Center must complete the documents below. Click on the links below to download the forms. Please download and save the fillable form to your computer first before filling in the information. Once the form is completed, save the form to your computer again and then print/fax/mail forms to the Asheville TEACCH Center. We are unable to schedule your family without the first three items.

1. Adult Professional Referral completed by a qualified professional: Physician, Nurse, Psychiatrist, Psychologist, Social Worker, Occupational Therapist, Teacher or other school personnel, Case Manager, Counselor, Speech Therapist, or Mental Health Worker. This professional must have knowledge of the client and an understanding of what ASD symptoms are present.
2. History Form for ALL Clients completed by the Adult Client. Versión en español
3. Copy of client’s insurance card and photo ID.

   ---

   Please also submit the following items:
4. Any other previous diagnostic and/or cognitive evaluation reports as indicated on the History form must also be submitted. Examples (if applicable, must include copies of): IEPs; school testing report(s); CDSA evaluation(s); notes from speech, occupational, and/or play therapy; notes from other mental health providers, etc. Please only include the most recent copy of IEP, therapy evals, etc.)
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. Versión en español
6. UNC General Consent for Treatment – Versión en español
7. Research Forms – Please review these forms and brochure – English and Spanish 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.  Versión en español  |  Folleto (español)  You are NOT required to participate in research to receive TEACCH services.

An adult who is seeking intervention services from the Asheville TEACCH Center and already has a documented diagnosis of Autism Spectrum Disorder must complete the documents below. Click on the links below to download the forms. Please download and save the fillable form to your computer first before filling in the information. Once the form is completed, save the form to your computer again and then print/fax/mail forms to the Asheville TEACCH Center. We are unable to schedule your family without the first three items.

1. A diagnostic report confirming the diagnosis of Autism Spectrum Disorder must be submitted
2. History Form for ALL Clients to be completed by the Adult Client. Versión en español
3. Copy of client’s insurance card and photo ID.

   ---

   Please also submit the following items:
4. Any other previous diagnostic and/or cognitive evaluation reports as indicated on the History form must also be submitted. Examples (if applicable, must include copies of): IEPs; school testing report(s); CDSA evaluation(s); notes from speech, occupational, and/or play therapy; notes from other mental health providers, etc. Please only include the most recent copy of IEP, therapy evals, etc.)
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. Versión en español
6. UNC General Consent for Treatment – Versión en español
7. Any other previous diagnostic and/or cognitive evaluation reports as indicated on the History form must also be submitted.
8. Research Forms – Please review these forms and brochure – English and Spanish 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. Versión en español  |  Folleto (español)  You are NOT required to participate in research to receive TEACCH services.