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The Luminary Group

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Reason for care

Select date & time

1 Appointment info

2 Prescreener

Reason for care

3 Contact information

If you're reaching out on behalf of someone else, what is your relationship to that person? (e.g., parent, caregiver, spouse, case manager, other)

If reaching out for yourself-please leave blank

In a few sentences, what brings you here today? What kind of support are you hoping to find?

Limited to 600 characters

Has the person received a diagnosis related to an intellectual, developmental, or neurocognitive condition? Select all that apply:

Autism Intellectual Disability Down Syndrome Cerebral Palsy Traumatic Brain Injury / Neurocognitive Disorder Another genetic, developmental, or neurocognitive condition Not formally diagnosed, but suspected None of the above / prefer to discuss during consultation

What have you noticed that prompted you to reach out? Select all that apply:

Increased anxiety or worry Sadness, withdrawal, or low mood Big reactions to changes in routine or environment Difficulty communicating needs or frustration Sleep or eating changes Signs of a difficult past experience or trauma Escalating or challenging behavior (that we haven't been able to fully understand yet) Not sure — just know something feels different None of the above / prefer to discuss during consultation

Has the person received a formal mental health diagnosis? If so, which?

Limited to 600 characters

Is the person currently experiencing a mental health crisis or in need of immediate care?

If the person is currently experiencing a mental health crisis or needs immediate care, please call 988 (Suicide & Crisis Lifeline) or go to your nearest emergency room right away — we'll still follow up with you as soon as possible.

For medical emergencies, contact your healthcare provider or call 911. For mental health crises, call or text 988.

The Luminary Group

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THE CLIENT PORTAL IS NOT TO BE USED FOR EMERGENCY SITUATIONS. IF YOU OR OTHERS ARE IN IMMEDIATE DANGER OR EXPERIENCING A MEDICAL EMERGENCY, CALL 911 IMMEDIATELY.