A front and back copy of your insurance card

A front copy of your driver’s license

For ABA/Social Skills through insurance - A neurological report showing what tools and testing were used to reach the diagnosis of Autism (F84.0)

A script from the doctor for each service you are interested in with a diagnosis code on the script

Please fill out the entire intake packet in order to process your request.

Once we receive all of the documentation, an intake coordinator will verify your benefits and be in touch.







Directions: Please fill out the intake packet above in its entirety.  Once completed, please upload this intake to the Parent Portal.  Please include a copy of your driver’s license, the front and back of your insurance card, and a script from your doctor.