Person Requesting Information

    Are we allowed to leave a message or send an email?

    Do you have diagnosis report within the last year (Required for ABA)?

    Services Requested

    (ABA Only) Is there accessible parking for therapists for home sessions?

    Patient information

    Is there a secondary Insurance?

    How did you hear about us?

    If you are requesting services through your insurance, our Intake Department will need to verify your benefits.

    Please contact our insurance department for any questions 818-452-5478

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