Social Behavior Learning Solutions Pre-Admissions Inquiry

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Thank you for your interest in ABA services with Social Behavior Learning Solutions.

Here at SBLS we provide focused and comprehensive ABA treatment.

Treatment hours for Focused ABA at SBLS ranges between 15-25 hours per week.

Treatment hours for Comprehensive ABA at SBLS ranges between 30-40 hours per week.

Our treatment model also includes Parent/Caregiver Training. This means that parents/guardians will be expected to participate in treatment, in order to promote client generalization and maintenance of skills learned.

When families are signing on for services with us we expect that they meet 90% of their prescribed treatment hours. All treatment hour recommendations are based on Medical Necessity and not the parent availability for services. (For example: If you child is recommended for 25 hours of ABA therapy per week. You will be expected to schedule 20 hours of services per week at minimum).

We are ONLY accepting clients in our center based program in Livingston, NJ.

Below you will find our hours of operation and documents that will be request should you decide to sign up for services with us.

Hours of Operation:

Center Based: Monday-Friday 8:30am-4:30pm (Full-Time) or (Part Time) 8:30am-2pm, 11:30-4:30 pm)

Documents that will be needed if insurance covers:

ABA Referral
Autism Diagnosis

Thank you!

Email *

Today's Date: *

YYYY

Your First & Last Name: *

Phone Number: *

Your Relationship To The Child: *

Mother

Father

GrandMother

GrandFather

Aunt

Uncle

Sibling (over 18 years)

Required

Childs First & Last Name: *

Childs Date of Birth (D.O.B): *

YYYY

Childs Age *

Childs Diagnosis *

Child's Insurance Company: *

Aetna (Commercial)

Blue Cross Blue Shield (Commercial)

Horizon NJ Health (Medicaid)

UnitedHealthCare (Commercial)

UnitedHealthCare Community (Medicaid)

Cigna (Commercial)

Private Pay

Required

Insurance Member ID: *

Provider Phone Number: (Listed on the back of the insurance card) *

Insurance Policy Holder: *

Self/Child

Parent/Guardian

Required

If the Parent/Guardian is the policy holder please list first, last name and DOB below:

Residential Address: (house number, apartment number, street) *

Residential Zip Code? *

County of Residence: *

Center Based Service Hours (Please select all that best fits your needs) *

8:30-2:00 (M-F)

11:30-4:30 (M-F)

8:30-4:30 (M-F)

Required

What is the primary language spoken in the home? *

Has your child received ABA Therapy in the past? *

Does your child receive any other therapies? *

Speech Therapy

Occupational Therapy

Physical Therapy

Counseling

Feeding Therapy

Other

N/A

Required

(Why are you seeking therapy for your child and what are your concerns? *

How did you hear about us? *

By selecting "Yes" you are acknowledging that you have read the introduction paragraph above and understand that we base our recommendation for treatment hours on medical necessity and not parent/client availability. In addition, you are acknowledging that you understand we expect all families to meet 90% of their recommended hours. *

Yes

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