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Interested in Services?

Thank you for your interest in the Center for Active Minds! Please complete the form below to provide some information about the services you are seeking. Our administrative team will review your information and follow up with next steps regarding availability and the waitlist.

Your first name

Your last name

Your Email Address

Your Phone Number

Your Zipcode

Who are you seeking services for?

Myself

My Child

Other

If services are being requested for a minor, please select your relationship to the child.*

Legal Guardian Other

Potential Client’s Name

If the services are for yourself, enter your own full name. If the services are for someone else, enter that person's full name.

Potential Client's Age

What type of service are you looking for?

Therapy - Support with emotional, behavioral, or day-to-day functioning concerns. A formal diagnosis is not required; services may be appropriate when concerns are affecting daily functioning. Evaluation — Comprehensive evaluation for ADHD, anxiety, and other concerns, with diagnostic clarification and individualized recommendations for treatment, school accommodations, and next steps. Both. Therapy and Evaluation Autism Evaluation — If you are specifically seeking an autism evaluation, please select this option. Not Sure - I would like help determining which service may be appropriate.

If you were referred by a primary care provider, pediatrician, school, therapist, or another source, please enter their information below.

Autism Evaluation

Complete this section (Questions 1-5) only if you selected “Autism Evaluation” above.

If you selected any other option, please skip this section.

1. Has a doctor, teacher, parent, or other professional ever expressed concerns about the potential client's development or suggested a possible developmental condition, such as autism?

Autism Evaluation Section

2. Did the potential client experience any developmental delays?

Autism Evaluation Section

3. Do you have any concerns about the potential client engaging in repetitive behaviors, routines, rituals, or compulsive behaviors?

Autism Evaluation Section

4. Have you ever had, or do you currently have, concerns about the potential client's expressive or receptive language?

Autism Evaluation Section

5. Has a close family member, such as a parent or sibling of the potential client, ever been diagnosed with autism spectrum disorder (ASD), pervasive developmental disorder (PDD), or another developmental disability?

Autism Evaluation Section

What are you looking for support with? Please briefly describe the concerns, symptoms, or reason you are seeking services.

Current Diagnosis

If the potential client has a medical diagnosis, please list it below. If you are unsure, do not have a formal diagnosis, or are seeking an evaluation, please indicate that.

Does the potential client currently have a diagnosis?

Yes No Unsure Seeking Evaluation

If yes, please list the diagnosis:

Please note: A diagnosis is not required for therapy services and does not guarantee eligibility or placement with a CFAM provider.

Anticipated Availability

CFAM is currently anticipating potential openings for new clients beginning in mid-to-late December 2026 with Cassie and early January 2027 with Dr. Sarah. These timeframes are estimates for planning purposes only and do not guarantee that an appointment will be available. Availability may change based on current client treatment timelines and openings that become available.

Please Note

Joining our waitlist does not guarantee that services will be provided by CFAM or that an appointment will become available. Our team is committed to connecting individuals and families with appropriate care as quickly as possible.

We will review the information you provide within 24 hours. If we determine that our services are not an appropriate fit for your needs, we will contact you by email within 48 hours.

If you do not hear from us, you have been added to our waitlist. When an appointment becomes available, a member of our team will reach out to schedule a phone screen to determine whether our services are an appropriate fit at that time.

We greatly appreciate your understanding and patience as we work to connect you with appropriate care.

Waitlist Acknowledgment

I acknowledge that I have read and understand the waitlist information and disclaimer provided above.

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