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Request ABA services
Tell the team how to contact you, where you live, and which language you prefer. This is an initial inquiry—not clinical intake—and no medical records are requested.
Basic information
Fields marked with an asterisk are required. Do not include diagnoses, member IDs, records, or detailed health information.
What happens next
The team will review your basic information and explain current availability, benefits verification, referral or diagnostic requirements, assessment, and authorization steps that may apply.