ABA Therapy| Stepping Stones Behavioral Services

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What do we need to get started?

A written referral with the child’s diagnosis stating ABA evaluation and treatment is required.

Request Services

Child’s Information

Child’s Information

First Name

Last Name

DOB

Gender

Diagnosis

Current insurance

Primary Care Physician

Setting where services will be rendered

Home

School/Daycare

Community

Other

Has the child receive ABA services before?

Yes

How did you get to know us?

Parent’s or Legal Guardian’s Information

Parent/Guardian 1:

Parent/Guardian 1:

First Name

Last Name

Address , City, State, Zip Code

City

State

Zip Code

Phone Number

Marital Status

Parent/Guardian 2

Parent/Guardian 2:

First Name

Last Name

Address

City

State

Zip Code

Phone Number

Marital Status

Attachments

Attachments

Doctor’s referral/prescription

*Doctor’s referral/prescription

Insurance card front

*Insurance card front

-Insurance card back

*Insurance card back

Neuro/Comprehensive Psychological Evaluation

*Neuro/Comprehensive Psychological Evaluation

IEP (Individualized educational plan) if applies

*IEP (Individualized educational plan) if applies

Additional Evaluations (e.g., speech, occupational, previous behavior plans)

Parent Driver’s License/ID

Consent

I accept receiving notifications and promotional messages from Stepping Stones Behavioral Services according to the Terms and Conditions & Privacy Policy.

Hours of operation

Mon - Fri: 8:00 am - 6:30 pm
Saturday: 9:00 am - 1:00 pm
Sunday: Closed

I have a Question

Contact Us

Tel: (561) 223 1716

Email: office@steppingstonesbehavioral.com

Fax: (561) 247 7389

Request Services

What do we need to get started?

Request Services

Hours of operation

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