"Improving Lives" "by helping make today and tomorrow better for you and your family."

Client Intake Form

Client Intake Form

Filling out this form is the first step in our intake process that allows us to determine a timeline for service introduction. Your availability and location are the main factors that we are reviewing at this stage. We also ask that you input your current contact information, your child’s insurance details and any special considerations that are pertinent to your child’s therapy.

Benefits Verification

Benefits Verification

We use the information provided on the intake form to conduct eligibility and benefits verification. Autism Care West is a Participating Provider with Anthem Blue Cross Blue Shield, Aetna, Sierra Health & Life, UHC, UMR and HealthScope insurance carriers. Autism Care West does not participate with Medicaid or ATAP funding.

Meet the Founder & Owner

Meet the Founder & Owner

Following the first two steps, we invite you to come and meet with Charles Marriott to discuss our approach to ABA services & staff management; we want to ensure that all your questions are answered and that you understand the requirements of our program model before moving forward with our intake process.