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BBM Connect · Intake Form

BBM Connect Family Needs Assessment

Helping Families Navigate Every Step—from Diagnosis to Daily Living.

Welcome to BBM Connect, a program of Brilliant Beyond Measure. Whether your child has recently received a diagnosis or you’ve been navigating this journey for years, we’re here to help. This intake allows us to better understand your family’s needs so we can connect you with appropriate resources, programs, and support.

⏰ Estimated completion time: 5–10 minutes
1. Parent / Guardian Information
2. Child Information
3. Diagnosis Information
4. How Can We Support Your Family?
5. Tell Us About Your Child
6. Current Services
7. How Did You Hear About Brilliant Beyond Measure?
8. Additional Information
9. Stay Connected
10. Consent
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Thank You for Connecting With Us

Your BBM Connect intake form has been received.

A member of the Brilliant Beyond Measure team will review the information you provided and contact you regarding available resources, referrals, programs, or possible next steps.

Please note: Submitting this form does not establish a medical, legal, therapeutic, or professional client relationship with Brilliant Beyond Measure.