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)

    Upload Your File