Tutoring Agreement Tutoring Agreement Tutoring Agreement Are You a TAM client? NoYes Start Date * Frequency * x a week TAM Client Treating Therapist * Child's First Name * Child's Last Name * DOB * Contact Information Child's First Name * Child's Last Name * DOB * Address Address Address Address Address Address State AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Address Phone * Email * Responsible Party First Name * Responsible Party First Name * Relationship to Patient * MotherFatherGrandparentBrotherSisterLegal Guardian Checkboxes * I understand that I am responsible for the fee of this service, which is $50. Payment is due at the time services are rendered. Payment can be made at https://www.teamautism.org/payment. Captcha Submit If you are human, leave this field blank.