Client Intake Forms

Download Client Intake PDF Form

Thank you for considering Peak Behavioral Center for your child’s behavioral needs. Before we begin, please download and review the client intake form below. When completed, please email the completed form to info@peakbc.com along with the following documents:

  1. Insurance card (front and back).
  2. Diagnostic Report indicating a diagnosis of ASD (Common examples are the CARs, CDE, and GARS-3).
  3. ABA Referral (Date given must be within the last 6 months).
  4. If you are leaving a previous ABA provider, please provide your most recent treatment plan.
  5. If you are leaving a previous ABA provider, please provide discharge paperwork.

These documents are all required for approval via insurance. If you have any questions regarding private pay, obtaining the above documents, or are in need of an ADOS-2 assessment please call 321-800-3770.

Please note: Completing our intake form and sending in your documentation is not a guarantee that we have availability or that we will be starting treatment. Available spots are limited for in clinic and we do our best to accomodate families as quickly and consistently as possible. All cases are reviewed on a case by case basis.