Now Accepting Clients in Orange, Charlottesville, Crozet!
We are currently accepting clients in the Orange, Charlottesville, and Crozet areas. Please complete the form to be contacted about securing your spot today!
Name
*
First Name
Last Name
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Child's Name
*
First Name
Last Name
Child Date of Birth
*
-
Month
-
Day
Year
Date
Does your child have an ASD (F84.0) Medical Diagnosis?
*
Please Select
Yes
No
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Locations
We are able to provide services in the home or in private daycare settings in areas surrounding Orange, Charlottesville, and Crozet. Our morning sessions occur up to 2 pm, with afternoon sessions at either 2:00 - 5:00 or 3:00 - 6:00 pm.
Which location are you interested in?
*
Orange
Charlottesville
Crozet
Which time slot would you be interested in? (check all that apply)
*
Mornings (Before 2 pm)
2:00 pm to 5:00 pm
3:00 pm to 6:00 pm
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Areas of Concern
Please tell us a little about your child and the reason you are seeking services.
How does your child communicate?
*
Vocal Speech
Emerging Vocal Speech
AAC Device
Picture Exchange System (PECS)
Gestures/Pulling/Pointing
Sign
Activities of Daily Living (Select all that apply)
*
Feeds themself
Toilet Trained
Independent dressing
Are there any behaviors you'd like to see reduced? (please list or describe)
*
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Insurance Type:
*
Commercial
Medicaid
Tricare
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Submit
Thank you for your interest in acquiring ABA Services.
Unfortunately, commercial insurance will only approve ABA services for children with a medical diagnosis of Autism Spectrum Disorder. Resources for Diagnostic Providers can be provided to you if you would like to call our office (540) 738-7720
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