ABC Group - ABA Waitlist Application
  
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Aloha and thank you for your interest in ABC Group Hawaii! 

Please read the following BEFORE filling out the form. 

IMPORTANT TO READ:  
1. Completing this FORM is neither a commitment or a guarantee to join our ABA program! 
2. After completing this FORM, you will receive an email from us to schedule a phone interview with our director. You may also call our clinic now to schedule this phone interview at 808-277-7736.
3. THE PHONE INTERVIEW IS REQUIRED TO BE ADDED TO OUR ABA WAITLIST.  YOU WILL NOT BE PLACED ON OUR WAITLIST UNTIL YOU AFTER YOU PARTICIPATE IN THE PHONE INTERVIEW WITH OUR DIRECTOR. 
4. Once you complete the phone interview, you may be placed on our waitlist, depending on triage criteria. You will need to be responsive to our emails and phone calls, when we alert you that a space at our clinic will be available. If you do not respond after 3 attempts (2 email and 1 phone call), we will move down the list to offer that spot to other parents on the list. 

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IMPORTANT INFORMATION ABOUT ABC: 
-Applied Behavior Analysis (ABA) therapy on Oahu for over 20 years!  
-Intensive clinic-based medically-necessary ABA treatment in Mapunapuna/Honolulu
-Medically-necessary ABA treatment reduces symptoms of autism, and can close the gap between developmental and chronological age (catch up to peers!)
-An "alternative school setting" requiring attendance Monday-Fridays.  
-ABA Treatment is intensive and generally requires a 3-year roadmap and committment! 
-ABA Treatment teaches your child new skills, like communication/language, reduces challenging behaviors, tests out needed accommodations, and caregivers will learn techniques to carry over the behavior plans at home/community as well as learning compassionate acceptance in order to enjoy your child's life- & for lasting change after therapy ends. 

-We do not conduct diagnostic evaluations to obtain a diagnosuis. 
We require at least 85% attendance. Consistency of sessions are what drives your child's progress in ABA treatment programs and produces the best outcomes from treatment. It is like taking daily medication to treat any other diagnosis. You won't get better unless you take the medicine. 

-We do not provide AFTER SCHOOL ONLY ABA to new clients. 
We reserve our AFTER SCHOOL ONLY session hours for those kids who graduate from our INTENSIVE ABA PROGRAMS. 

FUNDING INFORMATION: 
-We ONLY accept the following sources of in-network insurance funding and other for those children with an Autism diagnosis:
1. HMSA (Commercial PPO/HMO or Federal),
2. MedQuest (HMSA & Aloha Care) 
3. DOE Placement via Your Child's IEP (non-insurance based)
4. Cash Payments through our Concierge Program (non-insurance based and no ASD diagnosis needed).

*WE ARE NOT IN NETWORK WITH KAISER, TRICARE, UNITED HEALTH CARE OR AETNA. If you have these or any others that we are not in network with as a  secondary insurance, it will be your responsibility to submit your own claims. We will provide you with a superbill only.

NO DIAGNOSIS YET? 
-For those children with suspected autism (eg. who have symptoms of autism, but no formal diagnosis yet, we can help your Primary Care Provider (PCP) or physician make a referral while you are awaiting your diagnostic evaluation appointment to obtain a diagnosis of autism. -There is no need to wait for a diagnosis to begin ABA treatment, or to get on a waitlist. 
-You may also visit the Caregivers Tab on our website for an Autism Diagnosis M-CHAT screening tool form to fill out and print to take to your Primary Care Physician or Pediatrician. 

Thank you again for taking the time to share information with us about your child. We look forward to the opportunity to meet your family and potentially partnering with you to improve your child's future by using the science of ABA. 

Check out the Caregivers tab on our website to learn more about ABA https://abcgrouphawaii.com/caregivers
Please watch this 2 minute video on the importance of starting early in ABA treatment: 
Parent/Guardian Full Name (Point of Contact) *
Phone Number and Name of Caregiver #1 (AKA the person filling out this form) (please double check for accuracy)  *
Email Address of Caregiver #1
Phone Number and Email of Caregiver #2 
What zip code do  you live in? (we ask this because you will be commuting to 96819 zip code for ABA treatment in our clinic)   *
If English is not your primary language, would you benefit from translation services if your child is accepted for treatment, that MAY be available through your health plan (MedQuest)? If yes, please indicate your language of preference in "Other". 
Child's Full Name *
Child's Birthdate *
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Child's current PRIMARY Insurance Funder (we only accept HMSA or Aloha Care) *
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