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Early Intervention Form

Empower your child with Bauer ABA. Fill out our form to kickstart a personalized plan for success. Take the first step towards a brighter future today!

Bauer ABA and Early Intervention » Early Intervention Form

Get In Touch

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Parent/Guardian Name*

First Last

Child's Full Name

Child's Date of Birth

Email*

Phone

Insurance Type

Please select the following conditions for which your child has an official diagnosis.

ASD

ADHD

Intellectual Disability

N/A – My child needs a diagnostic evaluation

What type of school/daycare program is your child enrolled in?

Full Day

Partial Day

What treatment plans are you looking for?

Speech-Language Therapy

Applied Behavior Analysis

Feeding Therapy

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Early Intervention Form

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