CLINIC: Waitlist Form

Waitlist Form

Clinic-Based ABA Services | Columbia, MD 21045 (Opening December 2026)
Snowflakes ABA is preparing to open a center-based ABA clinic in Columbia, Maryland, with a target opening date on December 2026. We’re currently gathering interest from families who are seeking center-based ABA services as we prepare for our opening and assess initial capacity.

By joining our waitlist, your family can be among the first to be contacted about service availability and next steps.

Upcoming Clinic Hours: Monday–Friday, 9:00 AM–5:00 PM
Location: Columbia, MD (ZIP code to be announced)

Please complete the form below to let us know about your family’s interest and service needs. Submitting this form does not guarantee enrollment or a start date, as placement will depend on clinical needs, staffing, and available capacity.

We look forward to learning more about your family and keeping you informed as we prepare to open!
You and Your Child
Parent's Name

First NameLast Name
Parent's Email
example@example.com
Parent's Phone
Please enter a valid phone number.Format: (000) 000-0000.
City/Town
Zip Code
Child's Name

First NameLast Name
Child's age
Child's Birthdate

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Does your child have a diagnosis for autism?

Other
Coordination of Benefits

Note: Coordination of Benefits (COB) helps us determine the correct order in which your insurance plans will be billed. If your child is covered under more than one plan, please list both below. Providing accurate insurance information upfront allows us to verify your child's benefits before services begin and avoid any delays or unexpected costs.
Primary Insurance
Other Insurance: If other, what primary insurance do you have?
Subscriber's Name
Full name of the primary policyholder exactly as it appears on the insurance card.
Subscriber's Date of Birth
Member's ID
Secondary Insurance
Other Insurance: If other, what secondary insurance do you have?
Availability

Note: We have generally more daytime availability than afterschool and evening, due to clinician preferences and availability preferences
What hours of availability do you have for your child? Select all that you can do:

Other
Additional Information
Former client: Is this child a former client of Snowflakes ABA?

Other
Gender Requirement for RBT: Do you have a strict gender requirement for the RBT?
Any other comments or notes?
Form completed by
Referral
How did you hear about Snowflake ABA?

Other
Please name your physician or referral source.
Thank you for your interest in Snowflakes ABA!
Should be Empty:

Waitlist Form

You and Your Child

Coordination of Benefits

Availability

Additional Information

Referral