Apply for ABA Services

Ready to get started?  Thats great news!  Complete an application below for the type of funding you plan to use.  Once submitted, we will call you to discuss the next steps in starting your ABA journey!  Please do not hesitate to contact us with any questions or concerns you may have prior to submitting your application.

What Do I Need To Apply for ABA Services?

  • Applicant name, home address, phone number & e-mail
  • Client name, date of birth & home address
  • Insurance name
  • Member number 
  • Copy of the front and back of insurance card
  • Secondary Insurance Information, if applicable
  • Primary Care Physician name, agency, phone number
  • DSM Diagnosis documentation
  • Diagnosing Physician name, agency and phone number
  • Any additional DSM diagnoses

Medicaid Only:  Copy of prescription for ABA services.