[vc_row][vc_column width=”1/1″][vc_empty_space height=”32px”][/vc_column][/vc_row][vc_row][vc_column width=”1/1″][vc_custom_heading text=”Robots4Autism Client Admission Survey” font_container=”tag:h2|text_align:center” google_fonts=”font_family:Abril%20Fatface%3Aregular|font_style:400%20regular%3A400%3Anormal”][/vc_column][/vc_row][vc_row][vc_column width=”1/1″][vc_custom_heading text=”Please complete the following survey. You must answer truthfully to the best of your ability. Please only complete this survey if you are the parent of a child on the spectrum, or a guardian able to give consent for therapeutic programming. All other submissions will be disqualified. If you do not provide valid contact information, we will not be able to reach you. ” font_container=”tag:h3|text_align:left” google_fonts=”font_family:Neuton%3A200%2C300%2Cregular%2Citalic%2C700%2C800|font_style:400%20regular%3A400%3Anormal”][/vc_column][/vc_row][vc_row][vc_column width=”1/1″][vc_raw_js]

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[/vc_raw_js][/vc_column][/vc_row][vc_row][vc_column width=”1/1″][vc_custom_heading text=”Disclaimer: Completing this survey does not guarantee that the client will be eligible for therapy through this program. Therapeutic services provided through this selection process are not free of charge; we will inform you about cost if you are selected for the program. We have worked very hard to keep costs low for parents, and a portion of the funds obtained through this program will be used to purchase additional Milo units for the benefit of the community. ” font_container=”tag:h3|text_align:left” google_fonts=”font_family:Neuton%3A200%2C300%2Cregular%2Citalic%2C700%2C800|font_style:400%20regular%3A400%3Anormal”][/vc_column][/vc_row]