ABA enrollment

No Contracts Required!
No Minimum Hours of Therapy Required!

Please complete the form below to get started with our intake process.

Your name(Required)

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Email(Required)

Phone(Required)

Please select the closest location(Required)

*For Temple Only: Inquiries will be placed on our waitlist. You will receive notification once hours become available.

Please select your insurance carrier (We are not a provider with Medicaid, StarKids, CHIP, Superior Health, or Humana)(Required)

*For the Medicaid, StarKids, CHIP, or Humana plans that we do not accept, Cash-Pay services are available.

Insurance provider(Required)

Child's name(Required)

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Child's gender(Required)

Child's birthdate(Required)

Diagnosis (If none, please use our Contact Us form to learn about getting an ADOS assessment)(Required)

How did you hear about us?(Required)

Which event?(Required)

Which doctor?(Required)

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