Unlimited ABA Sports materials

Parent Intake Forms

Everything you need to get started with Unlimited ABA Sports

What to Expect

01

Complete the Form

Fill out the intake screening form below with your child's information.

02

We Review

Our team reviews your submission and reaches out to schedule a consultation.

03

Initial Consultation

Meet with our BCBA to discuss your child’s needs and develop an initial plan.

04

Begin Therapy

Start your child’s personalized ABA therapy program.

Intake Screening Form

Complete the form below to get started. Fields marked with * are required. You can also download the PDF intake packet if you prefer.

Child Information

Child's Name

Date of Birth

Sponsor / Insurance ID

Caregiver #1

Full Name

Phone

Address

Email

Caregiver #2

Full Name

Phone

Address

Email

Diagnosis Information

Autism Diagnosis Date

Diagnosing Facility

Facility State

Diagnosis Level

Medical Information

Current Medications

Allergies

Seizure History

Other Diagnoses

Family Autism History

Communication & Behavior

Main Form of Communication

Main Areas of Concern

Aggressive Behavior History

Previous Behavior Interventions

Sensory Needs / Aversions

School Information

School Name / Teacher

School Phone

School Address

Active IEP

Grade Level / Placement

School-Based Services Interest

Primary Care Physician

Name / Affiliation

Address

Phone

Current / Past Services

List any current or past therapy services your child receives.

Physical Therapy

Speech Therapy

Early Intervention

Occupational Therapy

Other

Other Service Providers

Home & Availability

Who Lives in the Home

Child's Availability for Therapy

Other Important Information

Document Uploads

Upload any relevant documents. Accepted formats: PDF, DOC, DOCX, JPG, PNG.

Recent IEP / BIP

Records of Therapy

Diagnostic Information

Insurance Cards

Supporting Every Step

Ready to get started?

Schedule a free consultation to discuss your child's needs. We accept most major insurance plans and are here to help your family every step of the way.

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