Autism Relief + Support Program Client Forms

Become an Autism Relief + Support Program's client

If you would like to become an Autism Relief + Support Program’s client, please click below to be directed to our secure payment and intake forms, which can be submitted online. The cost of the program is $440 for a two months supply of all remedies required, a 10 minute consultation and shipping to your home (US domestic addresses only). Click below to be directed to our secure credit card payment form. Once payment is submitted, you will be directed to our online intake forms, which can be filled out and submitted online. After your payment and intake forms are submitted, we will ship your DIY + Product package (and any additional purchases you might make) and contact you by phone to schedule your consultation no later than our second business day after submission.

Our business days for orders, shipping and billing are Tuesday through Friday, 9am to 4pm Central Time.

Office Hours: Monday through Friday 9am-4pm Central Time

Have questions? Get in touch with us!

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