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ABA Services Readiness Questionnaire
Answer 10 questions and share your contact details so we can follow up about ABA options in NYC.
How familiar are you with ABA (Applied Behavior Analysis) therapy?
*
Very familiar
Somewhat familiar
Not familiar at all
Have you previously used ABA services for your child?
*
Yes, currently using
Yes, in the past
No, never
How urgent is your need for ABA services?
*
Immediate (within 1 month)
Soon (1-3 months)
Not urgent
What is your main goal for ABA therapy?
*
Improve communication skills
Reduce challenging behaviors
Increase independence
Other
How involved are you able to be in your child's ABA sessions?
*
Very involved (can attend sessions regularly)
Somewhat involved (can attend occasionally)
Not involved (cannot attend)
What is your preferred setting for ABA therapy?
*
Home-based
Clinic-based
School-based
No preference
What is your child's age group?
*
0-3 years
4-7 years
8-12 years
13+ years
How do you prefer to communicate with your ABA provider?
*
Phone call
Email
Text message
No preference
Do you have insurance coverage for ABA services?
*
Yes
No
Not sure
Aetna
Emblem Health
Carelon Network
NYSHIP
NY Medicaid
Private pay
What is your biggest challenge in finding ABA services?
*
Availability of providers
Cost/insurance
Location
Quality of care
Other
Parent/Guardian Full Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Neighborhood in New York City
*
Please Select
Manhattan
Brooklyn
Queens
Bronx
Staten Island
Other
What are your main pain points or concerns regarding ABA services?
Best time to call you back
*
Please Select
Morning (8am - 12pm)
Afternoon (12pm - 5pm)
Evening (5pm - 8pm)
Anytime
See My Score & Request a Call Back
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