Start Client Intake & Verify Insurance

Parent / Guardian Information

Please provide primary guardian contact details below to initialize verification.

Guardian Full Name * Please enter your full name.

Relation to Child * Please select your relationship status.

Email Address * Please enter a valid email address.

Phone Number * Please enter a valid phone number.

City / Township * Please select your primary township.

Child Developmental Profile

All details are treated strictly in compliance with HIPAA medical privacy frameworks.

Child's Name / Initials * Please enter child's name or initials.

Child's Age (Years) * Please enter child's age (1-21).

Autism Spectrum Diagnosis Status *

Diagnosed Spectrum Seeking Evaluation

Insurance Coordination Details

Coordination is entirely managed by us. No hidden fees or board consult costs.

Primary Insurance Provider * Please select your primary insurance provider.

Member Insurance ID * Please enter member insurance card ID.

Clinical Notes / Behavioral Goals (Optional)

* By submitting, you authorize Bright Path ABA to contact your insurance carrier for the sole purpose of verifying behavior analysis therapy benefits. Your data is protected.

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Intake Profile Received!

Thank you for trusting Bright Path ABA. Your intake profile has been securely compiled. Our dedicated clinical advisor will contact you within **24 business hours** to outline benefit scopes and schedule assessments.

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Our Standard Guidelines

Caretaker Coordination

Direct Phone Consultation

Call us directly for immediate coordination questions.

(908) 301-6173

100% HIPAA Medical Safeguard

All data, clinical details, diagnoses and insurance ID codes are handled in compliance with HIPAA medical privacy frameworks.

Initial Assessment Process

Once benefits are approved, a licensed BCBA conducts 2-3 sessions of in-home play observation to catalog developmental baselines and design programs.

Start Secure Client Intake