Contact Request – Kerry's Place

WE CAN HELP!

Please complete the Contact Request form below and someone from our Intake Team will get back to you.

NEED HELP BY PHONE?

Toll Free: 1-833-77-KERRY (1-833-775-3779)
or email us at intake@nullkerrysplace.org

Name (Person with ASD Diagnosis)*
First Last
Contact Parent/Guardian’/Decision Maker’s Name
First Last
Contact email address*
Contact phone number
Service Region*
If “other” was specified, please indicate your region or city below
Please let us know what services or supports you are interested in...

THANK YOU FOR YOUR MESSAGE.

WE WILL REPLY TO YOUR MESSAGE WITHIN 2 BUSINESS DAYS.