APPLY FOR SERVICES

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), transition, interacting play, independent play, and independent living skills such as (showering, dressing, grooming, toileting, eating, house chores, self-regulation and more)

Click the image below to access the CentralReach form

CHILD'S INFORMATION:

Diagnosis Assessment / Neurological Assessment OR Psy. D Evaluation
(max 2.5mb): Individualized Educational Plan (I.E.P.) / Early Steps Evaluation (max 2.5mb):

Doctors Assessment include Behavioral Intervention Prescription W/Diagnosis (max 2.5mb): Speech and Language and/or Occupational Therapy (max 2.5mb):

PARENT'S OR LEGAL GUARDIAN'S INFORMATION:

Parent/Guardian 1:

Driver License Picture Front (max 2.5mb):

Driver License Picture Back (max 2.5mb):

Parent/Guardian 2:

Driver License Picture Front (max 2.5mb):

Driver License Picture Back (max 2.5mb):

INSURANCE INFORMATION:

PRIMARY INSURANCE:

Front of insurance card (max 2.5mb):

Back of insurance card (max 2.5mb):

SECONDARY INSURANCE: