8323 NW 12th Street, Suite 216. Doral, FL 33126

Registration Form

Please fill in the form below.

Child's Diagnosis (choose one or more)*


Setting (choose one or more)*

Availability (choose one or more)*

Please upload the following intake documents:

1) Copy of the child's insurance card

2) Referral for ABA services

3) Recent evaluation (e.g., IEP, Early Steps assessment, psychological, developmental assessment or neurological)