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Center for Autism, Assertiveness & Social Skills- CAASS

Clinical Counseling Helping Teens & Adults with Autism & Social Challenges!

Providers

Kenneth J. Smith, MS, MA, LPCC-S, Founder

Casey Stockett, Coach Associate from HMT ltd.

Destiny Segovia, MA, LPC, Associate from HMT ltd

Kellen Weber, MEd, LPC, Associate from HMT ltd

CONTACT FORM. Taking new clients!

New Clients please check all current available times/locations combinations that you are able to get services at: *

FRIDAY 7AM-2PM @ COLUMBUS Ohio Office IN-PERSON
MONDAY 7AM-9PM @ HOMEWORTH/ALLIANCE Ohio Office IN-PERSON (Homeworth is 2.5 hours from Columbus)
MONDAY & FRIDAY 7AM-2PM EST @ ONLINE VIDEO office (for Ohio residents only)
Alternating SATURDAY 11AM-3PM @ COLUMBUS Ohio Office IN-PERSON
Online Coaching Sessions- Various Days/Times Available (US residents only)
Need Other Info- Contacting CAASS for other information (e.g., client records, consultation, speaking requests)/anything other than becoming new client

FAST SCHEDULING: 1st SESSIONS 1-2 WEEKS FROM CLIENT CONTACT. Above time/location combos are the only current availability for new clients. If you do not see an office/time combination you can do, check back in a month or two to see if there are more/different availability. Please DO NOT FILL OUT this form if you can't do the times above, we do not keep a waiting list. More availability and other in-network insurance plans starting late August 2023 as a new provider will start then.

What services are you interested in? *

CAASS does not provide assessment for government/disability/social security services. DO NOT FILL out this form if you need help with these only.

How will you pay for services/what health insurance company do you have? CAASS offers a significantly discounted self-pay rate. *

Name of Perspective Client or Person Wanting Info *

First

Last

What do you need/what challenges would you like help with? *

PLEASE don't send sensitive personal or clinical information via this form.

Email *

Phone number *

Best way to contact you *

Both email and phone are good
Email best
Phone Best

Age of prospective client if Under AGE 18 or under guardianship

Name of Person Filling Out This Form (if different from above)

First

Last

Anyone is welcome to use this form to make inquires about CAASS services for themselves or anyone else but be aware that if the perspective new client is a legal adult (age 18+) and not under the legal guardianship of person filling out form, this adult perspective client needs to contact CAASS directly to make an appointment and needs to sign all paperwork themselves. PARENTS OF LEGAL ADULTS CANNOT MAKE APPOINTMENTS FOR ADULT CHILDREN unless adult child has authorized CAASS to do so. If the perspective client is a minor (age 12-17) the parent or legal guardian should fill out form. Legal documentation is required to establish legal guardianship. If minor's parents are divorced, legal documentation needs to be provided to show parent making appointment has the right to make health care decisions for minor.

What is the main way you found out about CAASS?

Word of Mouth/Personal Referral
CAASS website
Web Search
Psychology Today
Another Mental/Medical Health Practioner
Read an article/YouTube Video
Other
Not Sure/Prefer Not to Answer

Phone

Current Clients

If you need to contact your provider please contact them though the client portal (best way) or call or email them directly.

Office Locations

Online Coaching Services
Columbus, Ohio
New Albany, Ohio
Homeworth, Ohio

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