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Thank you for your interest in working with Sunshine ABA Therapy. Please fill out the following preliminary assessment questionnaire form and we will be in touch!

Before starting the process, we need you to sign the consent to request the authorization to the health insurance. We will send you via email the documents to be signed. As soon as you have signed and returned the consent form, we can check Eligibility of Benefits with Insurance and start the process. You should have the following documents ready.

If you do not have all the documents listed below, it is okay. We can talk through it together.

  • Psychologist Evaluation/ Autism Diagnosis
  • Referral for ABA therapy / Letter of Medical necessity
  • IEP report
  • Photo of Insurance card of the recipient (Front and back)
  • Driver License of the Parent or Legal Guardian
  • Assessment & Discharge from the previous ABA Provider, if any
What is your child insurance carrier?*
What is your child’s diagnosis?*
Does your child have IEP (Educational Program) at school? *
Does your child have Autism Diagnosis/ Psychological Evaluation*
Does your child have Letter of Medical Necessity/Referral for ABA within the last year?*
Which are the problem behaviors the child exhibits (select all that apply)?*
How would you describe your child’s expressive communication (select all that apply)?*
Overall, which challenging behavior does your child display?*
Did the child have ABA therapy before us?*
Have you applied to another ABA Therapy company within the last 2 months?*
Are you on the Waiting list with another ABA Therapy company?*
Is Your child receiving other therapies (select all that apply)?*
What is the availability for ABA therapy with your child (select all that apply)?*
File size limit of 10MB. You can upload PDF, doc, docx, txt, xls, xlsx, csv, jpeg, jpg, gif and png files.