At Growing Foundations ABA Therapy, we believe every child deserves personalized support to reach their full potential. Our enrollment process is simple and designed to guide you every step of the way—from initial assessment to starting services. Whether you are new to ABA Therapy or transitioning from another provider, we are here to make the process smooth, supportive, and stress-free.

The Enrollment Process

Once we have received the required documents and information requested below and processed them, we will reach out to your
insurance company to ensure we can provide ABA Therapy under your policy. Once approved, our Board Certified Behavior Analyst (BCBA) will schedule an Initial Assessment. They will gather information about developmental history, behaviors, and concerns. Growing Foundations ABA Therapy is with you every step of the way to help grow strong foundations for the next generation.

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Today's Date *

Child's Name *

First

Middle

Last

Child's Date of Birth *

Child's Gender *

• Male
• Female

Child's Home Address *

Address Line 1

Address Line 2

City

— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Is The Child Currently Supported By An IEP? *

• Yes
• No

Is The Child Currently Receiving ABA Therapy *

• Yes
• No

Previous ABA Therapy Records Document Upload

Drag & Drop Files, Choose Files to Upload You can upload up to 2 files.

Choose Files to Upload. You can upload up to 2 files.

Child's Situation *

• Child lives with Mom
• Child lives with Dad
• Child lives with both parents

What Services Are You Looking for? Select all that Apply *

• In-Home
• Center-Based
• Group-Based
• Parent Trainings

Custodial Parent 1 Name *

Custodial Parent 1 Email *

Email

Confirm Email

Custodial Parent 1 Phone *

Custodial Parent 1 Phone Type *

• Mobile
• Home
• Work

Custodial Parent 2 Name

Custodial Parent 2 Email

Email

Confirm Email

Custodial Parent 2 Phone Number

Custodial Parent Is

Custodial Parent 2 Phone Type

• Mobile
• Home
• Work

ABA Prescription/Referral and Autism Diagnosis Report Document Upload *

Drag & Drop Files, Choose Files to Upload You can upload up to 3 files.

Please submit below the following documents required to begin receiving services: – Doctor’s Prescription/Referral for Applied Behavioral Analysis (ABA) with an Autism Spectrum Disorder (ASD) diagnosis as well as a Autism Diagnosis Report from qualified physician. Choose Files to Upload.

Insurance Provider *

Member ID *

Group # *

Policyholders Name (Usually a Parent) *

Front and Back of Insurance Card Upload *

Drag & Drop Files, Choose Files to Upload You can upload up to 2 files.

Front and Back of Insurance Card Upload.

Submit