{"id":100,"date":"2022-08-30T17:34:40","date_gmt":"2022-08-30T17:34:40","guid":{"rendered":"https:\/\/genesisbehaviorcenter.com\/lasvegas-nv\/request-services\/"},"modified":"2025-03-21T10:09:17","modified_gmt":"2025-03-21T10:09:17","slug":"request-services","status":"publish","type":"page","link":"https:\/\/genesisbehaviorcenter.com\/lasvegas-nv\/request-services\/","title":{"rendered":"Request Services"},"content":{"rendered":"<\/div><\/div><\/div><!-- close content main div --><\/div><\/div><div id='full_slider_1' class='avia-fullwidth-slider main_color avia-shadow   container_wrap sidebar_right'   ><div  data-size='no scaling'  data-lightbox_size='large'  data-animation='slide'  data-ids='23,28,27'  data-video_counter='0'  data-autoplay='true'  data-bg_slider='false'  data-slide_height=''  data-handle='av_slideshow_full'  data-interval='7'  data-class=' '  data-css_id=''  data-scroll_down=''  data-control_layout='av-control-hidden'  data-custom_markup=''  data-perma_caption=''  data-autoplay_stopper=''  data-image_attachment=''  data-min_height='0px'  data-src=''  data-position='top left'  data-repeat='no-repeat'  data-attach='scroll'  data-stretch=''  class='avia-slideshow avia-slideshow-1  av-control-hidden av-default-height-applied avia-slideshow-no scaling av_slideshow_full   avia-slide-slider '  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/ImageObject\" ><ul class='avia-slideshow-inner' style='padding-bottom: 35.15625%;'><li  class=' slide-1 ' ><div data-rel='slideshow-1' class='avia-slide-wrap'  ><div class = \"caption_fullwidth av-slideshow-caption caption_center\"><div class = \"container caption_container\"><div class = \"slideshow_caption\"><div class = \"slideshow_inner_caption\"><div class = \"slideshow_align_caption\"><h2  style='font-size:40px; color:#ffffff; ' class='avia-caption-title '  itemprop=\"name\" >New Beginnings for Children with Autism<\/h2><div class='avia-caption-content  av_inherit_color'  itemprop=\"description\"   style='font-size:30px; color:#ffffff; '><p>Effective research-based services for children with Autism Spectrum Disorder and various behaviors.<\/p>\n<\/div><\/div><\/div><\/div><\/div><\/div><img src='https:\/\/genesisbehaviorcenter.com\/lasvegas-nv\/wp-content\/uploads\/sites\/2\/2025\/03\/home_banner-1024x360.jpg' width='1024' height='360' title='home_banner-1024x360' alt='Genesis ABA Therapy Background with Mom'  itemprop=\"thumbnailUrl\"   \/><\/div><\/li><li  class=' slide-2 ' ><div data-rel='slideshow-1' class='avia-slide-wrap'  ><div class = \"caption_fullwidth av-slideshow-caption caption_center\"><div class = \"container caption_container\"><div class = \"slideshow_caption\"><div class = \"slideshow_inner_caption\"><div class = \"slideshow_align_caption\"><h2  style='font-size:40px; ' class='avia-caption-title '  itemprop=\"name\" >Genesis Behavior Center<\/h2><div class='avia-caption-content  av_inherit_color'  itemprop=\"description\"   style='font-size:30px; '><p>Providing Behavioral Intervention and Treatment through Applied Behavioral Analyis.<\/p>\n<\/div><\/div><\/div><\/div><\/div><\/div><img src='https:\/\/genesisbehaviorcenter.com\/lasvegas-nv\/wp-content\/uploads\/sites\/2\/2025\/03\/parents_banner-1024x360.png' width='1024' height='360' title='parents_banner-1024x360' alt='Genesis ABA Therapy Background with Dad'  itemprop=\"thumbnailUrl\"   \/><\/div><\/li><li  class=' slide-3 ' ><div data-rel='slideshow-1' class='avia-slide-wrap'  ><div class = \"caption_fullwidth av-slideshow-caption caption_center\"><div class = \"container caption_container\"><div class = \"slideshow_caption\"><div class = \"slideshow_inner_caption\"><div class = \"slideshow_align_caption\"><h2  style='font-size:40px; ' class='avia-caption-title '  itemprop=\"name\" >Center Based Site<\/h2><div class='avia-caption-content  av_inherit_color'  itemprop=\"description\"   style='font-size:30px; '><p>Available for families whose children are enrolled in Early Intensive Behavior Treatment (EIBT) programs.<\/p>\n<\/div><\/div><\/div><\/div><\/div><\/div><img src='https:\/\/genesisbehaviorcenter.com\/lasvegas-nv\/wp-content\/uploads\/sites\/2\/2025\/03\/treatment_banner-1024x360.png' width='1024' height='360' title='treatment_banner-1024x360' alt='Genesis ABA Therapy Background with Hands'  itemprop=\"thumbnailUrl\"   \/><\/div><\/li><\/ul><div class='avia-slideshow-arrows avia-slideshow-controls'><a href='#prev' class='prev-slide' aria-hidden='true' data-av_icon='\ue87c' data-av_iconfont='entypo-fontello'>Previous<\/a><a href='#next' class='next-slide' aria-hidden='true' data-av_icon='\ue87d' data-av_iconfont='entypo-fontello'>Next<\/a><\/div><div class='avia-slideshow-dots avia-slideshow-controls'><a href='#1' class='goto-slide active' >1<\/a><a href='#2' class='goto-slide ' >2<\/a><a href='#3' class='goto-slide ' >3<\/a><\/div><\/div><\/div>\n<form action=\"https:\/\/genesisbehaviorcenter.com\/lasvegas-nv\/request-services\/\" method=\"post\"  class=\"avia_ajax_form av-form-labels-visible    \" data-avia-form-id=\"1\" data-avia-redirect=''><fieldset><h3>Client Intake\/Application<\/h3><p class=' first_form  form_element form_element_half' id='element_avia_1_1'><label for=\"avia_1_1\">Client First Name <abbr class=\"required\" title=\"required\">*<\/abbr><\/label> <input name=\"avia_1_1\" class=\"text_input is_empty\" type=\"text\" id=\"avia_1_1\" value=\"\" \/><\/p><p class=' form_element form_element_half' id='element_avia_2_1'><label for=\"avia_2_1\">Client Last Name <abbr class=\"required\" title=\"required\">*<\/abbr><\/label> <input name=\"avia_2_1\" class=\"text_input is_empty\" type=\"text\" id=\"avia_2_1\" value=\"\" \/><\/p><p class=' first_form  form_element form_element_half' id='element_avia_3_1'><label for=\"avia_3_1\">E-Mail <abbr class=\"required\" title=\"required\">*<\/abbr><\/label> <input name=\"avia_3_1\" class=\"text_input is_email\" type=\"text\" id=\"avia_3_1\" value=\"\" \/><\/p><p class=' form_element form_element_half' id='element_avia_4_1'><label for=\"avia_4_1\">Client Birthday <abbr class=\"required\" title=\"required\">*<\/abbr><\/label> <input name=\"avia_4_1\" class=\"avia_datepicker text_input is_empty\" type=\"text\" id=\"avia_4_1\" value=\"\" placeholder=\"DD \/ MM \/ YY\" \/><\/p><p class=' first_form  form_element form_element_half' id='element_avia_5_1'><label for=\"avia_5_1\">Guardian\u2019s First Name <abbr class=\"required\" title=\"required\">*<\/abbr><\/label> <input name=\"avia_5_1\" class=\"text_input is_empty\" type=\"text\" id=\"avia_5_1\" value=\"\" \/><\/p><p class=' form_element form_element_half' id='element_avia_6_1'><label for=\"avia_6_1\">Guardian\u2019s Last Name <abbr class=\"required\" title=\"required\">*<\/abbr><\/label> <input name=\"avia_6_1\" class=\"text_input is_empty\" type=\"text\" id=\"avia_6_1\" value=\"\" \/><\/p><p class=' first_form  form_element form_element_half' id='element_avia_7_1'><label for=\"avia_7_1\">Primary Guardian\u2019s Email <abbr class=\"required\" title=\"required\">*<\/abbr><\/label> <input name=\"avia_7_1\" class=\"text_input is_email\" type=\"text\" id=\"avia_7_1\" value=\"\" \/><\/p><p class=' form_element form_element_half' id='element_avia_8_1'><label for=\"avia_8_1\">Primary Guardian\u2019s Phone <abbr class=\"required\" title=\"required\">*<\/abbr><\/label> <input name=\"avia_8_1\" class=\"text_input is_empty\" type=\"text\" id=\"avia_8_1\" value=\"\" \/><\/p><p class=' first_form  form_element form_fullwidth' id='element_avia_9_1'><label for=\"avia_9_1\">Address <abbr class=\"required\" title=\"required\">*<\/abbr><\/label> <input name=\"avia_9_1\" class=\"text_input is_empty\" type=\"text\" id=\"avia_9_1\" value=\"\" \/><\/p><p class=' first_form  form_element form_element_half' id='element_avia_10_1'><label for=\"avia_10_1\">City <abbr class=\"required\" title=\"required\">*<\/abbr><\/label> <input name=\"avia_10_1\" class=\"text_input is_empty\" type=\"text\" id=\"avia_10_1\" value=\"\" \/><\/p><p class=' form_element form_element_fourth' id='element_avia_11_1'><label for=\"avia_11_1\">State <abbr class=\"required\" title=\"required\">*<\/abbr><\/label> <input name=\"avia_11_1\" class=\"text_input is_empty\" type=\"text\" id=\"avia_11_1\" value=\"\" \/><\/p><p class=' form_element form_element_fourth' id='element_avia_12_1'><label for=\"avia_12_1\">Zip <abbr class=\"required\" title=\"required\">*<\/abbr><\/label> <input name=\"avia_12_1\" class=\"text_input is_empty\" type=\"text\" id=\"avia_12_1\" value=\"\" \/><\/p><p class=' first_form  form_element form_fullwidth' id='element_avia_13_1'><label for=\"avia_13_1\">Current Diagnosis <abbr class=\"required\" title=\"required\">*<\/abbr><\/label> <select  name=\"avia_13_1\" class=\"select is_empty\" id=\"avia_13_1\"><option  value ='Autistic Disorder'>Autistic Disorder<\/option><option  value ='Aspergers Disorder'>Aspergers Disorder<\/option><option  value ='Pervasive Developmental Disorder (PDD-NOS)'>Pervasive Developmental Disorder (PDD-NOS)<\/option><option  value ='Other'>Other<\/option><option  value ='Not Yet Diagnosed'>Not Yet Diagnosed<\/option><\/select><\/p><p class=' first_form  form_element form_fullwidth' id='element_avia_14_1'><label for=\"avia_14_1\">School Attending if applicable<\/label> <input name=\"avia_14_1\" class=\"text_input \" type=\"text\" id=\"avia_14_1\" value=\"\" \/><\/p><p class=' first_form  form_element form_element_half' id='element_avia_15_1'><label for=\"avia_15_1\">Primary Spoken Language<\/label> <input name=\"avia_15_1\" class=\"text_input \" type=\"text\" id=\"avia_15_1\" value=\"\" \/><\/p><p class=' form_element form_element_half' id='element_avia_16_1'><label for=\"avia_16_1\">Client Gender<\/label> <select  name=\"avia_16_1\" class=\"select \" id=\"avia_16_1\"><option  value ='Male'>Male<\/option><option  value ='Female'>Female<\/option><option  value ='Prefer noto answer'>Prefer noto answer<\/option><\/select><\/p><p class=' first_form  form_element form_element_half' id='element_avia_17_1'><label for=\"avia_17_1\">Primary Guardian<\/label> <select  name=\"avia_17_1\" class=\"select \" id=\"avia_17_1\"><option  value ='Father'>Father<\/option><option  value ='Mother'>Mother<\/option><option  value ='Other'>Other<\/option><\/select><\/p><p class=' form_element form_element_half' id='element_avia_18_1'><label for=\"avia_18_1\">Referred By:<\/label> <select  name=\"avia_18_1\" class=\"select \" id=\"avia_18_1\"><option  value ='Doctor'>Doctor<\/option><option  value ='Relative'>Relative<\/option><option  value ='School'>School<\/option><option  value ='Other'>Other<\/option><\/select><\/p><p class=' first_form  form_element form_fullwidth' id='element_avia_19_1'>\t <label for=\"avia_19_1\" class=\"textare_label hidden textare_label_avia_19_1\">Frequency of Current Treatments &amp; Services<\/label>\t <textarea  name=\"avia_19_1\" class=\"text_area \" cols=\"40\" rows=\"7\" id=\"avia_19_1\" 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