Provider Referrals

If you are a parent or guardian, please click here to get started.

Referring providers can submit referrals via fax to (210) 579-7100 or the referral form below. For faxed referrals, please include the patient’s insurance information, medical diagnosis, and medical records.

 

Please use the following form to refer a patient for ABA services.

Child’s details
Your child’s first name
Your child’s last name
Their birthday
MM slash DD slash YYYY
Gender
Parent/Guardian details
Parent/Guardian first name
Parent/Guardian last name
Email Address
Phone number
Preferred location
Other details
Referring Provider
Insurance Provider
Service needed
Service needed
Please include requested documents below. We look forward to speaking with you soon!
Diagnostic Report
Max. file size: 50 MB.
Insurance card
Max. file size: 50 MB.

Getting started is
as easy as 1 2 3

1

Fill out our fast and easy contact form by clicking “Get Started”

2

Speak with our expert staff and get all your questions answered as well as a tour of one of our clinics

3

We will verify your insurance benefits, review these with you, and request an authorization for an ABA assessment