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Please answer the following questions to the best of your knowledge.  The purpose of this questionnaire is to help our team better understand what your family is looking for with regards to ABA services, and to help the onboarding process move as efficiently as possible once it begins.  Once completed, our team will notify you of openings for services and the additional steps necessary to begin onboarding.


If you have any questions, please email us at or call us at (774) 241-0001.

If you need to return to this form, please click on the link sent to your email.

The following documents will be required. Place a check next to each document that you currently have.
Has the patient received ABA services in the past?
Does your child currently attend school?
Is the patient currently receiving ABA services outside of school?
Where are you looking for ABA services to occur?
Insurance companies do no cover the cost of transportation for ABA services. Are you available to transport your child to and from services? Please discuss this with our team if you are not available.
Place a check next to each day of the week you are available for ABA services.
Place a check next to the time of day are you looking for ABA services. Most sessions are between 2-4 hours long.
Please note that parent meetings are a crucial part of your child's success, and is required by most insurance companies. These meetings may occur in-person on a regular basis.
Brandis Center Inc. is considered a hands-off company. For this reason, you may be referred to another ABA provider or a recommendation of a higher level of care may be given. Please discuss any prior history of agression with our team.
Please understand that some insurance companies require co-pays, co-insurance, and/or deductables to be paid for each session. It is ultimately the member's responsibility to understand their plan and to pay any required fees associated with their plan.
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.
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