Insurance Reimbursement Form

*Due to the passing of SB946 in July 2012, insurance is now mandated to pay for ABA/ Autism treatment. ABA is the only treatment option with empirical research and proven success. Please look into what exactly your insurance will cover.

Please answer the questions below and then email or fax us a copy of the front and back of your insurance identification card as well as Autism diagnosis and most recent report from your physician. This can be emailed to or faxed to 1-877-268-3922

You can also download this form and fill it out and fax it to us if you’d like.