Full Spectrum Affordability – Often ZERO out of pocket cost – Private Insurance

/Full Spectrum Affordability – Often ZERO out of pocket cost – Private Insurance
Full Spectrum Affordability – Often ZERO out of pocket cost – Private Insurance2018-09-20T16:32:22+00:00
PAY ONLINE NOW

Private Pay Client Services

Easy online payment processing for Private Pay Clients is here.
PAY ONLINE NOW

Getting Started

STEP 1: Please complete a Patient Information form & Release of Information form.

Click on button to Download the forms, fill them manually and send through:
Address: 16414 Lake Church Drive, Odessa, FL 33556
Fax: (813) 920 9252
E-mail (scan forms and send to): newclients@fullspectrumaba.com

Download Forms
Download Forms

STEP 2: Obtain a script for “Applied Behavior Analysis Behavior Therapy” from your child’s doctor.

The script must include the child’s full name and birth date, be dated within the last year, and be signed by an MD or DO (no electronic signatures accepted). You can obtain the script directly from the doctor and fax to us at (813) 920-9252 or email to us at fsbaintake@fullspectrumaba.com  Alternatively, we can attempt to obtain the script from the child’s doctor, which may result in slightly longer processing times.  

IMPORTANT

Full Spectrum Behavior Analysis and our staff CANNOT move forward in obtaining authorization for your child’s ABA services unless these forms are filled in completely.

On the Release of Information form please make sure to write in the Doctor’s Name, and contact information so we can contact your child’s Doctor to obtain proof of diagnosis.

If you have any questions when completing this form, you may call us at (813) 926 5454

Contact Us

Contact us!!

Please call us at (813) 926 5454, FAX at (813) 920 9252 or email us at fsbaintake@fullspectrumaba.com
Contact Us
Translate »