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Phone: (214) 817-2457

Home
About ABA
What we Do
What to Expect
Montessori & ABA
Resources
FAQ
About Us
Contact Us
Careers

What you are looking for?

Contact Us

Name *

First

Last

copy in your

Email *

Email

Confirm Email

Phone *

City of Residence? *

Zip Code (this will help us match you with the closest therapist and BCBA) *

Services Sought

I am interested in... (Select all that apply) *

Clinic-Based ABA Therapy
Early Intensive ABA Child Intervention
Parent Coaching

My child is *

12 to 23 Months-old
2 years-old
3 years old
4 years old
5 years old
6 years old
7 years old
8 years old

Very Important: Has you child been given an official comprehensive Autism diagnostic by a qualified health professional such as a pediatrician, neurologist, or child psychologist? Screenings, school or education diagnostics are not accepted by insurance companies (See FAQ for more details about Comprehensive Autism Diagnostics).

Yes
No
I am not sure but I will check ASAP

If your child was formally diagnosed with autism, please indicate if the diagnostic was made in the last 36 months. This is very important! (copy)

Yes
No
I am not sure but I will check ASAP

Has your child received ABA services in the past? *

Yes
No

If you answered "Yes" above, for how long?

Insurance & Funding

Please indicate how you intend to pay for services *

Commercial Insurance (BCBS, Anthem, Optum/UHC)
Medicaid
Self/Private Pay
Other source of funding

If you selected commercial insurance, which of the following do you have?

Blue Cross and Blue Shield
Anthem
Optum/UHC
Other source of funding

If you selected Medicaid, which of the following MCO manages your Medicaid plan?

Parkland
Wellpoint/Carelon formerly Amerigroup
Superior/Magellan
Other MCOs

Is your insurance in-state or out-of-state? *

In-state (e.g., BCBSTX)
Out-of-state (e.g., BCBS North Carolina)
Unknown

Do you have a secondary insurance? (If yes, please indicate your secondary health insurance provider below) *

Please attach a copy of the front and back of your Insurance Card if you want us to check for eligibility and benefits

Drag & Drop Files, Choose Files to Upload You can upload up to 2 files.

If you attached a copy of your insurance Card above, please include your child's first and last name below as well as the date of birth (Month, Day, Year)

How did you discover ABA Vibe? *

When would you like to begin services? *

What is the best way to reach you? *

email
phone
SMS

Additional Information

Email *

Couple meeting with an ABA specialist for a free consultation

Contact Form

Turn Around Time

We do our best to reply to inquiries within one to two hours (when made during business hours). Inquiries made after business hours will be receive a response the next day.

Tel: (214) 817-2457

Business hours

Monday - Friday : 8:00 am - 4:30 pm
Saturday : By Appointment
Sunday: Closed

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Home
About ABA
What we Do
What to Expect
Montessori & ABA
Resources
FAQ
About Us
Contact Us
Careers