The HEC  program my child is in is:     Hillcrest Center ASD Program

349 Old Stockbridge Road

Lenox, MA 01240

My child’s Treatment Team is Team __________________________.

The program’s phone number is (413)637-2834

My child’s Clinician’s name is ______________________________________________.

His/her telephone extension is Extension_________________________.

His/her supervisor’s name is ______________________________.

His/her supervisor’s telephone extension is Extension ___________.

The Program Director’s name is ________________________________________.

His/her telephone extension is Extension__________________________.

The telephone extension for the Nurse’s Office is Extension _______________.