To begin working with the University Autism Center, complete an application or referral form.

Forms

Application Form

In this form, you’ll be asked questions about your child’s development and medical history. Our clinical team will review your form and, if appropriate, contact you about making an evaluation or treatment appointment.

Outside Agency Referral

This form is for outside agency use. You’ll be asked about your client’s personal and medical information as well as your reason for referral.

Privacy Practices

This is a summary of the Center's Notice of Privacy Practices and describes how the Autism Center may use and disclose protected health information and how you can access this information. This applies to the clinical programs at the Autism Center.

Request Information

Fill out this form to request more information from the Autism Center. Ask about our diagnostic, treatment, and screening services. We’ll connect you with a center staff member to answer your questions.

Contact Us
Location
Office
611 N. Fountain
Cape Girardeau, MO 63701
Mailing Address
One University Plaza, MS 9450
Cape Girardeau, MO 63701