Confidence Connection

Center for Children with Autism

Are there any interfering behaviors? *

Secondary Insurance *

What services/needs are you looking for? *

What does your child’s educational and therapeutic program look like? *

Additional Notes:

How does your child communicate? *

Age/DOB: *

What are you child's strengths/weaknesses? How are their play skills? *

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What are some of your child’s favorite things (movies, toys, music, foods, iPads?) *

Email: *

Primary Insurance: *

Parent Name: *

What are the parent's goals/objectives for the child? *

Any other concerns? *

Child's Name: *

Phone Number *

Dear Parents,

After almost 25 years of dedicated service to children in the MA area, Confidence Connection will be closing on 8/22/25. If you need recommendations for other providers please email us.

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