*Please note all services are subject to staff availability and we currently have a waiting list for after school hours and in certain counties.
We will need a few pieces of information and documents in order to move the intake process forward:
1. Doctors Referral (no electronic signatures, must include client DOB, diagnosis and the recommendation that behavior analysis services are medically necessary. Dr. must be a medicaid provider) Valid for 1 year.
2. Diagnostic Report or Evidence of Behaviors (documented by Child Psychologist, Child Psychiatrist or Developmental Pediatrician ONLY, OR School county Evaluations or IEPs (Individualized Education Plans)
3. Copy of patient ID and/or both sides of insurance card.
These pieces of information may also be helpful to submit at this time if possible, but may be completed at the time of assessment.
4. Signed Consent Form (available here ---> https://drive.google.com/open?id=11qJ95OgUCxjbHcFjbIPrb3gmVHDYOrlZ)
5. Prior medical assessments, IEPs, evaluations and therapy records may also be submitted at this time.
6. Intake form (available here ---> https://drive.google.com/open?id=1DuWM_x2XdPJryXigvNYPcDXHIfDTd_GV)
After these things are completed, we will discuss any wait times that may be experienced. Once we have staffing, we will seek an authorization for an initial assessment.