Contact information
Aspire Behavioral Care Wait-list Information
Intake Process
To begin the intake process, please fill out the information below. If you have a referral from your primary care provider, please have them fax it to our office at 719-465-3914 or you can bring it in.

Someone will contact you to fill out our intake paperwork as well as get your insurance information on file. Once we have all of that information, we will contact you to set up an initial assessment with you and your child.

After the initial assessment, we will contact you to start services. It typically will take 2-3 months for morning/afternoon hours and about 3-4 months for evening hours depending on staff availability and processing time for insurance approval.

Please feel free to call our office or stop by at any time if you have any questions about this process, or would like a tour. You can reach us at 719-465-3695.

**UPDATE AUGUST 2019: If you have Medicaid, there have been some recent changes to documentation needed in order to start the intake process. Medicaid is now requiring a referral as well as a diagnostic tool (any tool/screening performed within the last 12 months that has a score/results) from the doctor in order for us to conduct an initial assessment for your child. Please feel free to call us if you have any questions.**
Guardian Name *
Your answer
Email *
Your answer
Address *
Your answer
Phone number *
Your answer
Name of Child Receiving Services *
Your answer
Client Date of Birth *
MM
/
DD
/
YYYY
Diagnosis *
Your answer
Primary Insurance *
Your answer
Secondary Insurance
Your answer
Primary Concerns *
Your answer
Referral Faxed to 719-465-3914 *
Required
What time of day do you prefer services?
What days of the week do you want services?
Additional Information
Your answer
Other Therapies Child Receives (Days and Times)
Your answer
Has the client ever received ABA services in the past?
How did you hear about Aspire?
Your answer
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