New Client Interest Form
Thank you for your interest in Infinity ABA Therapy & Autism Services LLC! We provide in-home ABA services to individuals affected by Autism, ADHD, developmental delays or other behaviors and social challenges utilizing only principles and methodologies of Applied Behavior Analysis. Please complete the New Client Interest Form so we can gather initial information about your child.

This form should be completed by the child's parent or legal guardian. Information provided by you will be held strictly confidential and will only be released in accordance with HIPAA guidelines and as mandated by law.

Email address *
Name of individual completing form *
Your answer
Relationship to Client *
How did you hear about Infinity ABA Therapy & Autism Services? *
Please provide the name of websites, organizations, and/or individual.
Your answer
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