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Autism Request Appointment

We have two locations at Henry Ford Medical Center - Troy and Henry Ford Medical Center - Hamtramck. Our center requires that you attend ABA therapy sessions Monday through Friday. Session times are 8:00 am -11:10 am (morning session), or 12:30 pm -3:40 pm (afternoon session).

To schedule ABA therapy services, please fill in and submit this form, and we will contact you within 48 hours.

Parent/Guardian First Name Parent/Guardian Last Name Child's First Name Child's Last Name Child's Age Child's Date of Birth What clinic would you prefer to receive services at? Which session time would you prefer? Does the child have an autism diagnosis from an approved evaluation center in Michigan Has the child ever gotten any service at a Henry Ford facility Name of the parent's health insurance plan Parent's Email Address Parent's Phone Number Please indicate your preferred method of contact

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