Language
English (US)
Spanish (Latin America)
Echoic Autism Center ~ A New Way to ABA
We’re excited to partner with your family!To best serve you, please complete our brief enrollment form. This will help us verify your insurance benefits and begin developing a personalized treatment plan for your child.By sharing this information, we can ensure your child receives the maximum possible benefit from our services.Your privacy is important to us. In accordance with HIPAA regulations, all personal health information is kept strictly confidential.
What services are you looking for?
In- Home ABA Therapy
In- Center ABA Therapy
Social Skills Group
Parent Training
Parent Support Groups
Parent Name
*
First Name
Last Name
Child's Name
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
City/ State
Email
*
example@example.com
Phone Number
*
Insurance Provider
*
Anthem/ BCBS
Medicaid
Amerigroup
Caresource
Optum/ UHC
Peachstate/ Ambetter
Self Pay
Other
Tell us more about your child
Let's get started!
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Submit
Should be Empty: