CHILL ACT

NEURODIVERGENT & KIDS' EXPO

Finding the Right Fit (Change of Support) Form

Expo Location

Which CHILL ACT Expo city are you attending?

Colorado Springs, CO — Mar 28, 2026

Phoenix, AZ — May 9, 2026

Dallas, TX — May 30, 2026

Miami, FL — Jun 6, 2026

Houston, TX — June 13, 2026

Salt Lake City, UT — Aug 8, 2026

Durham, NC — Aug 29, 2026

Last name

First name

Email

Phone

Multi-line address

Country/Region

Address

City

Zip / Postal code

Is your child currently working with one or more providers?

What’s Prompting the Change?

What’s not working as well as you’d hoped? (Select all that apply)

Consent & Disclaimer

By submitting this form, you acknowledge and consent to the collection and use of the information provided solely for the purpose of offering general guidance, resources, and community connections. All information shared is treated as confidential and will not be sold or shared outside of CHILL ACT and its trusted partners for support-related follow-up. This form is not medical, clinical, legal, or diagnostic advice and does not replace professional evaluation or services. C