New Client Intake

🔒 Submitting Documents Securely

To begin services, we'll need your child's diagnostic report and insurance information (insurance card, front and back). These documents help us verify coverage and start services faster.

Please do not email these documents. To keep your child's protected health information safe, we collect them through a private, HIPAA-compliant link.

How it works: Submit the intake form below, and our team will email you a private, secure upload link for your diagnostic report and insurance card.

Parent / Guardian Information

First Name *

Last Name *

Email *

Phone Number *

Relationship to Client *

Client Information

Client First Name *

Client Last Name *

Date of Birth *

Age *

We serve ages 2–22 years.

City *

We serve the Greater Seattle area and surrounding cities.

Diagnosis (if known)

Insurance & Services

Insurance Provider

Member ID (optional)

Which services are you interested in? *

Applied Behavior Analysis (ABA) Therapy

Parent Training & Coaching

Behavior Intervention Planning (BIP)

School & Community Collaboration

Telehealth ABA Services

Preferred Start Date

🔒 Submitting Documents Securely

Parent / Guardian Information

Client Information

Insurance & Services

Additional Information