Start Your Intake | ABA Therapy Enrollment

Your free consultation starts here — complete the form below and a member of our Intake team will reach out to verify your benefits and answer your questions, at no cost.

Please share the details below. Fields marked * are required.

Child

Child's first name *

Child's last name *

Child's date of birth *

Child's gender

Parent / guardian

Guardian first name *

Guardian last name *

Email address *

Phone *

Address

Apt #

Zip code *

Language

Insurance

Name of insurance *

Member ID number

Services

Are you interested in receiving ABA services at the Horizon Blue ABA Center? *

Center only, or in-home & center (hybrid)?

Preferred hours of service

Morning Day Afternoon

A little more

How did you hear about Horizon Blue ABA?

Anything else? (optional)

Documents optional — speeds up your intake

Have them handy? Upload your child's documents now and we can verify faster. Accepted: PDF, JPG, PNG (max 4 MB each). You can also send them later.

Diagnosis / psychological evaluation Choose a file or drag and drop

Insurance card — front Choose a file or drag and drop

Insurance card — back Choose a file or drag and drop

Photo ID — front Choose a file or drag and drop

🔒 Your information and any documents are sent securely to our team and never shared. Uploading now is optional — if you'd rather send documents later, our team will help you.

Prefer to talk first? Call us at (718) 212-0222.

Accepted Insurance Plans