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Your Child's Visit to the Autism Clinic

In order to provide you with the best care possible for your child at the Autism Multispecialty Clinic, several items are needed from you prior to your appointment.

  • First, you will need to fill out the comprehensive intake form, behavioral questionnaires and a release of information request. All of these forms must be completed in full. If you have any questions or are uncertain about anything in regards to this information, please contact me in advance of completing the forms. Once you finish filling out these forms you can either mail, email to and/or fax them to (501) 978-6483.

NOTE: Medical Specialists MUST review this paperwork prior to seeing your child, thus it is essential that the forms are completed and sent back well in advance of your appointment.

  • Second, you will need to provide documentation of the diagnosis of autism spectrum disorder in order to be seen in the clinic. We require you have this documentation sent to us well in advance of your appointment. Failure to have this documentation on file one month prior to your appointment will result in cancellation of your appointment. In the state of Arkansas the documentation of autism spectrum disorder requires agreement by a medical doctor, psychologist and speech therapist, documentation of the diagnosis from all of these professionals will be required if you live in the state of Arkansas. The documentation can be faxed to us at (501) 978-6483.

Additionally we see multiple patients at this clinic so please be aware of the following:

  • If we are not able to confirm your appointment at least two weeks prior to your appointment we will overbook this slot and give priority to the patient who has confirmed their appointment / completed paperwork.
  • The specialist may not be able to spend the necessary time for you and your child for a comprehensive evaluation if you do not send the complete set of paperwork back to us prior to your appointment.
  • You should arrive 25-30 minutes prior to your appointment time in order to be checked in at the front desk and go through registration in order to be seen on time by the physician.
  • Our policy is not to see patients that are 20 or more minutes late for an appointment, so if you are 20 or more minutes late you may not be seen and you may need to reschedule your appointment.
  • If you live more than two hours away and are aware that you will be late to your appointment you must call immediately to alert the nurses. Depending on how late you arrive we can only confirm that every effort will be made, but we cannot guarantee that you will be seen by your physician.
  • If you do not call and are considered a no-show for your appointment, you will not be rescheduled to the next available appointment unless requested, and you will not have access to the cancelation list.

The following is not applicable to patients with Arkansas Medicaid:

There are many reasons a child may develop an Autism Spectrum Disorder. We know that an Autism Spectrum Disorder is likely due to an interaction of genetic and environmental factors. Sometimes, a genetic factor can be identified through testing. Not all of our patients require genetic testing, but there are certain signs and symptoms that would warrant further investigation. Genetic testing can be helpful, but it is often expensive. If a child is covered by commercial insurance, then the cost of genetic testing may or may not be covered by that plan. Not all children need genetic testing, but if it is recommended at the appointment there are a few options available to make sure your child receives the best care, and to avoid your family receiving an unanticipated bill for testing:

Bring your child's insurance card to their appointment

  • At the appointment, use the information on your insurance card to call the customer service number and ask for prior authorization. We will provide the testing information you need to do this. If prior authorization cannot be given, then we can postpone testing until the insurance company can provide an answer.
  • If you do not wish to wait for testing, or prior authorization was not approved, we can perform genetic testing if you sign the next page. This documents that you accept responsibility to pay the remainder of what insurance does not pay for the test. Every effort will be made to inform you of the cost of a test before we order it.

Arkansas Children's Hospital
1 Children's Way
Little Rock, AR 72202-3591

Call: 501-364-4000


  1. Medical History Questionnaire
  2. Medication List

For NEW patients please complete the following:

  1. Medical History Questionnaire
  2. Medication List

For patients that have been to the clinic within the last two years please complete the following:

  1. Medication List
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