Provide us with brief demographics and overview of your child to make sure ABA services are appropriate.
Medical Authorization Form
The authorization of medical and educational release form gives the company permission to access and obtain to your child's records. This is necessary with aiding in the approval process and future collaboration with your child's caregivers (doctor's, teachers, OT, etc.)
Insurance Evaluation Approval
Pre-approval from insurance company (if applicable) is required prior to any evaluation, therapy, or other service being provided.
The documents collected will be submitted to the funding source will they will give an approval for an evaluation.
Complete Intake Packet
Permission to Videotape and Photograph
Client Registration Form
Authorization to Release Information
Authorization to Bill Insurance
Confidentiality Act-Abuse Reporting Protocol
HIPPA Service Agreement and Consent Form
The caregiver(s) and client will meet in-person with the BCBA. Indirect assessments and direct observation will be completed.
Final Approval for Services
The BCBA will use all information gathered through the evaluation and given by the doctor to create an individualized comprehensive Behavior Intervention Plan (BIP) which will be submitted to the funding source for a 6-month approval for services.