ABA Services – New Client Interest Form
Please note: We currently accept Medicaid insurance only.  We accept all Virginia Medicaid plans, with the exception of Kaiser Permanente Medicaid and the Medicaid United Healthcare Community Plan. However, we are working on contracting with other insurance providers at this time.

This form is the first step in our intake process to understand your child's needs and your interest in ABA therapy services. Individuals who complete this screening form will be assessed for initial eligibility. If we determine that they may meet eligibility criteria, they will be placed in a queue for services. Once an opening becomes available, a formal assessment will be scheduled to make a final determination of eligibility and to initiate services. If more information is needed, or if eligibility is not initially met, a member of our team will reach out to gather additional details or provide alternative resources. 

We currently provide in home ABA services in the City of Fredericksburg, Spotsylvania County, Stafford County, Prince William County, and in select areas of King George County and Caroline County.  

Our Caregiver Consultation program is open to all families within Virginia, however families outside of our in-home service area must travel to one of our office locations, in Fredericksburg, VA or Woodbridge, VA,  to participate in the initial evaluation and intake process (typically 1-2 visits). 

Our early intervention clinic is located in Spotsylvania County
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Please enter the name of the person completing this form, and their relationship to the individual. 
Forms should be completed by the child's parent or legal guardian.  
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