If you are a human and are seeing this field, please leave it blank. Fields marked with an * are required What is the age of the person with autism? Is the person with autism male or female? MaleFemale How many medications does the person take for autism? Is the person being treated for another medical condition? YesNo E-mail Address First Name Last Name Phone Number City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Comments
