Please complete this Intake Form regarding your child. Progressive Option Support Services views all the information that you provide us with as strictly confidential on this HIPAA compliant submission platform. This information is helpful for us in developing an initial understanding of your child’s needs and provides critical information for us to discuss with your insurance company to get authorization for services.
Please upload front and back copies of your insurance card, a copy of the autism evaluation report, and/or a copy of the doctor’s script with ASD diagnosis.
A MEMBER OF OUR STAFF WILL CONTACT YOU WITHIN 24HRS