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Step 1. Create Billing Contact
Step 2. Activate Account
Step 3. Account Activated

Contact Information       Note: Red text indicates required fields.
Billing First Name:
Billing Last Name:
Address 1:
Address 2:
Postal/Zip Code: 
Phone 1: 
Phone 2: 
Client #: 
Account Information
* We suggest your email address (Min Characters: 5)
Re-Type Password:  

Password Strength

Note: For the best Password Strength rating include:
  • Uppercase and lowercase characters
  • Numbers
  • Symbols
  • Eight or more characters
Extra Information
Gender Identity:
Gender Pronoun:
Guardian 1 Name:
Guardian 1 Phone:
Guardian 2 Name:
Guardian 2 Phone:
Emerg. Contact:
Emerg. #:
How did you hear about Ausome?:
How does your child best communicate? I.e. gestures, PECs system, fragmented speech, signs, full sentences etc. Please elaborate.:
Is your child fully toilet trained? If NO, please elaborate:
Is there anything else about your child that would be helpful for us to know? I.e. special interests, things to avoid or be aware of etc.:
What level of autism has your child been diagnosed with?:
This individual is a(n)...:
Medical Information
List any medication presently taken:

Do you have any of the following conditions or requirements?:
Allergies:  YesNoEpi-pen Required:  YesNo
Other Medical Conditions:  YesNo 

Please explain:  

I understand that, with the exception of the birthdate, the previous information only needs to be completed on the pages for child participants.
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