Refer a child for ABA services

Send our Columbus team the family’s basic contact information for potential ABA services.

Secure referralPlease do not enter Social Security numbers.

Child and parent

Only the three starred contact fields are required.

Child’s name * Parent/legal guardian’s name * Parent/legal guardian’s phone number *

Person making the referral Optional

Organization name Your name Your phone number Referral notes

Optional. PDF, JPG, or PNG; up to 20 MB per file.

Diagnosis or evaluation IEP or referral/order Insurance card

* Required