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Start ABA Services at Brandis Center Inc.

Brandis Center Inc. provides individualized ABA therapy for children in Sturbridge and surrounding Massachusetts communities. If you are interested in beginning services, complete the intake form below and our team will review your information and contact you regarding next steps, availability, and insurance.

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Please note that Brandis Center Inc. does not provide diagnostic evaluations for Autism Spectrum Disorder (ASD) or other qualifying conditions. Children applying for ABA services must already have an appropriate diagnosis. Families seeking an evaluation should contact their child’s healthcare provider for guidance.

Brandis Center Inc. is currently in-network with the following insurance plans:

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  • Blue Cross Blue Shield

  • MBHP (Massachusetts Behavioral Health Partnership)

  • Tufts (Public & Commercial Plans)

  • Aetna

  • First Health Network​

  • Curative

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If you are interested in ABA services at Brandis Center Inc., please complete the patient, parent/caregiver, insurance, and scheduling information below or call us at (774) 241-0001.

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Our team will review the information provided and may contact you for additional documentation as part of the intake process. To help protect your privacy, certain medical and clinical information will be requested later rather than through this initial form.

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

The insurance information you provide may be used to contact you, determine eligibility for services, verify insurance benefits, coordinate care, and begin the intake process.

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 based on Medical Necessity)
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

Privacy Notice

The information you provide through this form will be used by Brandis Center to contact you regarding your inquiry, determine eligibility for services, verify insurance benefits when appropriate, and begin the intake process. Information submitted through this form will be handled in accordance with applicable privacy laws and Brandis Center's Notice of Privacy Practices.

By submitting this form, you acknowledge that the information provided is accurate to the best of your knowledge and consent to being contacted by Brandis Center regarding your inquiry. Submission of this form does not establish a provider-patient relationship or guarantee admission into services.

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