ABA Request - Bend
New Summit is currently accepting new clients from 1-7 years of age. Please note that evening services are the most requested and quickest to fill. New Summit does require a commitment of 4 therapy sessions per week which is approximately 10 therapy hours.

Please fill out this form as completely as possible. This form is secure and HIPAA compliant so your information will stay safe. If you have any questions or concerns, email us at info@newsummitaba.com or call 541-224-6987.

All the best,
New Summit Behavioral Therapy
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Email *
Child's Name: *
Child's Birthday: *
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Parent/Guardian(s) Name(s): *
Phone Number: *
Address: *
Preferred Method of Contact
Does the child have an autism diagnosis? *
Does the client have any additional diagnosis? If yes, please indicate them.
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