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  • We serve children 0-5 years old with AUTISM diagnosis. We need a doctor’s prescription with the written diagnosis and recommending ABA services.
  • We work on extinguishing problem behaviors such as: physical aggression, verbal aggression, motor stereotypy, vocal stereotypy, Self-Injury Behavior, tantrum, property destruction, invading personal space, inappropriate social approach, food refusal, toilet accidents, non-compliance and more.
  • We work on developing academic, functional communication, compliance (follow instructions), transitiong, interacting play, independent play, and independent living skills such as (showering, dressing, grooming, toileting, eating, house chores, self-regulation and more)

CHILD'S INFORMATION:




Diagnosis Document:

PARENT'S OR LEGAL GUARDIAN'S INFORMATION:

Parent/Guardian 1:





Driver License Picture Front:
Parent/Guardian 2:





Driver License Picture Front:

INSURANCE INFORMATION:

PRIMARY INSURANCE:



Front of insurance card:
SECONDARY INSURANCE:



Front of insurance card:
DOCTORS INFORMATION: