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INITIAL INTAKE FORM

We currently accept the following insurance:

  • Blue Cross Blue Shield

  • MBHP (Massachusetts Behavioral Health Partnership) network through MassHealth

  • Tufts

  • Aetna

If you are interested in applying for ABA Services at Brandis Center Inc., please fill out the required patient, parent, and insurance information or contact us at (774) 241-0001.  We will review the information you provide and will likely request further information as necessary.  The protection of your personal information is our top priority, so certain information that will be required before starting services will be asked for at a later time.

Does the patient have a formal diagnosis of Autism Spectrum Disorder (ASD)?
Which block works best for your child's schedule?
How many days of ABA are you looking for?
Upload Insurance Card (front)
Upload Insurance Card (back)

Upon submitting this form, a member of our team will reach out to you via email and/or by phone.  You will also be sent an additional questionnaire to provide further information. 

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