Refer a Patient for ABA Therapy

The Behavior Change works with healthcare professionals to help children and families access individualized, evidence-based ABA services.

If you have a patient who may benefit from ABA therapy, complete the secure referral form below and upload the available referral documentation. Our team will review the information and contact the family within 1–2 business days.

For healthcare professionals and authorized referral sources.

Refer a Child to The Behavior Change

Physician / Provider Name*

Practice / Organization Name*

Specialty*

NPI Number*

Email Address*

Phone Number*

Fax Number*

Child's Name*

Date of Birth*

Parent / Guardian Name*

Parent / Guardian Phone*

Parent / Guardian Email*

State*

City*

Insurance*

What prompted this referral? Select all that apply.*

Please provide any additional information that may help our intake team understand the reason for referral.*

Physician Referral* Upload a file or drag and drop. jpg, jpeg, jpe, png, pdf up to 500MB

Diagnostic Evaluation Upload a file or drag and drop. jpg, jpeg, jpe, png, pdf up to 500MB

Insurance Card (Front & Back) Upload a file or drag and drop. jpg, jpeg, jpe, png, pdf up to 500MB

Referral Authorization:*

I acknowledge that I am submitting this information as a healthcare professional or authorized representative and that I am authorized to provide the patient information and documentation included with this referral.

I acknowledge that this referral form may contain protected health information and confirm that the information is being submitted for purposes related to coordinating the patient's care.

What Happens Next?

Once the referral is received, The Behavior Change's intake team will review the information and contact the child's parent or guardian within approximately 1 - 2 business days.

From there, we'll help the family understand the intake process, insurance requirements, and the steps necessary to determine whether ABA services are appropriate.

The referring provider does not need to take any additional action after submitting the referral unless our team contacts the practice for additional information.

Need Referral Resources?

Visit our physician resource center for materials designed to make ABA referrals easier for your team and the families you serve.

There, providers can access:

ABA Referral Kit
Autism Screening Cheat Sheet
Information about our services
Referral guidance

Visit For Physicians

Refer a Patient for ABA Therapy

Refer a Child to The Behavior Change

What Happens Next?

Need Referral Resources?

About TBC

Contact details

For Professionals