Intake Enrollment Form

Start Your Journey

Begin the ABA Therapy Enrollment Process

Getting started with services should feel simple. And, we’ve made sure it is. Our intake process is warm, straightforward, and focused on understanding your child’s individual needs. Just complete the secure intake form below, and our intake coordinator will reach out within 1–2 business days to schedule your initial consultation and walk you through the next steps.

What is your child insurance carrier?*
What is your child’s diagnosis? Check all that apply.*
Does your child have IEP (Educational Program) at school? *
Does your child have Autism Diagnosis/ Psychological Evaluation*
Does your child have Letter of Medical Necessity/Referral for ABA within the last year?*
Which are the problem behaviors the child exhibits (select all that apply)?*
How would you describe your child’s expressive communication (select all that apply)?*
Overall, which challenging behavior does your child display?*
Did the child have ABA therapy before us?*
Have you applied to another ABA Therapy company within the last 2 months?*
Are you on the Waiting list with another ABA Therapy company?*
Is Your child receiving other therapies (select all that apply)?*
What is the availability for ABA therapy with your child (select all that apply)?*
File size limit of 10MB. You can upload PDF, doc, docx, txt, xls, xlsx, csv, jpeg, jpg, gif and png files.