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Speak with an EAS Specialist Today
Speak with an EAS Specialist Today
Speak with an EAS Specialist Today
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Please indicate whether you are a client or employee.
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Client
Employee
Therapy Type
*
In-Home Therapy
Center-Based Therapy
Purpose
*
Checking-In
Checking-Out
Monitoring Symptoms
Date
*
MM slash DD slash YYYY
Check-In Time
:
Hours
Minutes
AM
PM
AM/PM
Check-Out Time
*
:
Hours
Minutes
AM
PM
AM/PM
First Name
*
Last Name
*
Temperature
*
Have you, or anyone in your home experienced any of these symptoms in the past 72 hours.
*
No Symptoms
Fever (Temperature over 100.0 F)
Sweats/Chills
Difficulty Breathing
Constant Dry Cough
Chronic Fatigue
Severe Cold/Flu-like Symptoms
Congestion or Sneezing
Unexplained Headaches or Muscle Aches
Diarrhea
Vomiting
Other
Other Symptoms
If other, please explain.
Are any of these symptoms due to a pre-existing or unrelated medical condition?
*
No Symptoms
Yes
No
Have you or anyone in your home been exposed to someone with Coronavirus (COVID-19)?
*
Yes
No
Maybe
Have you or anyone in your home been exposed to someone showing Coronavirus (COVID-19) symptoms?
*
Yes
No
Maybe
If exposed, has it been addressed and resolved?
*
How many days passed after exposure and work release?
*
Have you or anyone in your home traveled domestically, or internationally, within the past 14 days?
*
Yes
No
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Home
About Us
Our Services
In-Home ABA Therapy
Center-Based ABA Therapy
Telehealth Services
Social Skills Groups
Free Learning Courses
Our Locations
United States
Alabama
Birmingham
Montgomery
Georgia
Atlanta
Duluth
Idaho
Illinois
Chicago
St. Louis
Maryland
Michigan
Detroit (Tri-County Area)
Ann Arbor
Missouri
Oregon
Portland
Salem
Tennessee
Virginia
Australia
Queensland
Victoria
India
Hyderabad, Telangana
Karnataka
Resources for Parents
Free Learning Courses
Autism FAQs
Our Therapy Programs
Behavior Therapy
Fine & Gross Motor Skills
Language & Communication
Play
Autism Teaching Strategies
Self-Help
Social Skills
Getting Started
EAS Blogs, Videos & Podcast
Resource Directory
Research & Helpful Resources