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Your journey begins here.

Please note: Our office does not provide evaluations for Autism Spectrum Disorder (ASD) or other disorders.  All patients applying for ABA therapy must already have a diagnosis of ASD.  Please contact your child's healthcare provider regarding being evaluated for ASD.

We current accept the following insurance plans.

  • Blue Cross Blue Shield

  • MBHP (Massachusetts Behavioral Health Partnership) network through MassHealth

  • Tufts

  • Aetna

Our center-based program is currently for children 2-12 years of age.  

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.

New Patient Contact Form

Patient Gender (as listed on their insurance)
Male
Female
Other
Does the patient have a diagnosis of Autism Spectrum Disorder (ASD)?
Yes
No
Other
Which block(s) work best for the patient to receive ABA? (select all that apply)
How many days of ABA are you looking for? (our team will work with you on a recommendation)
1 day per week
2 days per week
3 days per week
4 days per week
5 days per week
Other/Unknown
Which day(s) of the week is the patient available for ABA? (select all that apply)
Has the patient received ABA in the past?
Yes
No
Other
Does the patient currently attend school (including pre-k)?
Yes
No
Other
If yes, when does the patient attend school?
Full Day
Morning only
Afternoon only
Other
Does the patient have a history of physically aggressive behaviors towards adults or other children?
Yes
No
Other
For all new patients, an initial assessment is required prior to development of a treatment plan and beginning ABA services. The assessment process, once started, can take 6 or more weeks to complete.
I understand
Other
Based on findings after initial assessment, your child may be referred to another ABA provider, or a recommendation of a higher level of care may be given.
I understand
Other
Parent meetings & trainings are a crucial part of your child's success and are required by most insurance companies. These meetings may occur in-person on a regular basis.
I understand
Other
Are you available to transport the patient to and from center-based services? We do not provide transportation, however those on MassHealth may be eligible for PT-1 transportation.
Yes
No
If our agency does not currently have an opening, I would like to be placed on a wait list. In many cases our wait list can be 3-6 months or more. However, openings can occur at any time.
Yes
No
I hereby authorize Brandis Center Inc. to use the information provided on this form for the sole purpose of verifying the patient’s insurance eligibility and benefits for Applied Behavior Analysis (ABA) services.
I authorize Brandis Center to use this information
Other
I understand that the information I have provided will be kept confidential and handled in accordance with applicable privacy laws, including the Health Insurance Portability and Accountability Act (HIPAA).
I understand
Other
I certify that the information provided on this form is accurate to the best of my knowledge. I acknowledge that it is my responsibility to inform Brandis Center Inc. promptly of any changes to the patient’s personal, medical, or insurance information.
I certify that the information provided is accurate
Other
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