Hello fellow providers and professionals. Please use this HIPAA compliant intake form to refer clients who would benefit from Parent-Led ABA, Social Skills Training, or IEP Advocacy.
Keep in mind of the following:
Anyone can refer a patient, as long as they receive parent consent
No diagnosis required to receive services
Services can be funded through SDP and Private-Pay with the option of applying for our Sliding Fee Scale Program
Find a list of funding options we currently collaborate with here.
Process Transparency
Referral received -> Funding Verified -> Intake Scheduled with family
Referring Person Information
Preferred Method of Contact
Referred Individual's Information
Parent / Legal Guardian Information
*Relation to Referred Individual
*Anticipated Funding Source
Answer the following, If applicable
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What happens next?
Confirmation: You will receive an automated notification that your submission was received successfully by our secure server. We will review your referral packet within 1 business day.
Referral Review: Our dedicated intake team will review the documentation provided to determine the appropriate funding options and next steps. If additional information is needed, we will contact the referring party.
Family Outreach: We will contact the family directly within 2 business days to discuss their needs, explain available services, and coordinate an initial consultation or intake.
Service Coordination: Once services and funding arrangements are confirmed, we will coordinate scheduling and provide any necessary intake documents or service agreements.
