Effective research-based services for children with Autism Spectrum Disorder and various behaviors.
Providing Behavioral Intervention and Treatment through Applied Behavioral Analyis.
Available for families whose children are enrolled in Early Intensive Behavior Treatment (EIBT) programs.
Client First Name *
Client Last Name *
Client Birthday *
Guardian’s First Name *
Guardian’s Last Name *
Primary Guardian’s Email *
Primary Guardian’s Phone *
Current Diagnosis * Autistic DisorderAspergers DisorderPervasive Developmental Disorder (PDD-NOS)OtherNot Yet Diagnosed
School Attending if applicable
Primary Spoken Language
Client Gender MaleFemalePrefer noto answer
Primary Guardian FatherMotherOther
Referred By: DoctorRelativeSchoolOther
Frequency of Current Treatments & Services
Secondary Insurance (if Applicable)
3 + 4 = ? Please prove that you are human by solving the equation *
Phone: (877) 828-8476
Fax: (877) 252-3970
Mon - Fri: 9:00 am - 6:00 pm
Sat - Sun: Closed
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