Skip to content
Main Menu
Why DASI?
Menu Toggle
About Us
Our Process at DASI
Meet the Team
What Makes DASI Different
Testimonials
Careers
Parents & Families
Menu Toggle
About Autism & ABA
Resources
Funding
Services
Menu Toggle
Home-Based ABA Therapy
Center-Based ABA Therapy
Speech Therapy
Occupational Therapy
Educational Partnerships
Contact
Enroll Your Child
Enroll Your Child
Main Menu
Why DASI?
Menu Toggle
About Us
Our Process at DASI
Meet the Team
What Makes DASI Different
Testimonials
Careers
Parents & Families
Menu Toggle
About Autism & ABA
Resources
Funding
Services
Menu Toggle
Home-Based ABA Therapy
Center-Based ABA Therapy
Speech Therapy
Occupational Therapy
Educational Partnerships
Contact
Enroll Your Child
Enroll Your Child
Get Started
Ready to Begin the Enrollment Process?
Our in-house team handles the insurance processing for each family. We will work with you to coordinate the best combination of funding to ensure your child receives the services they need. Please fill out the following information to help us determine your coverage. Once we receive the information, a member of our team will reach out to you to discuss options.
Child's Name
*
First
Last
Gender
*
Male
Female
Child's Date of Birth
*
Date Format: MM slash DD slash YYYY
Has your child received a diagnosis of Autism?
*
Yes
No
Father's Name
First
Last
Father's Date of Birth
*
Date Format: MM slash DD slash YYYY
Mother's Name
First
Last
Mother's Date of Birth
*
Date Format: MM slash DD slash YYYY
Email
*
What’s the best email to reach you at?
Phone
*
What’s the best number to reach you at?
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Primary Insurance
*
Primary Insurance ID #
*
Primary Policy Holder's Name
Secondary Insurance
*
Secondary Insurance ID #
*
Secondary Policy Holder's Name
Desired service?
*
Home-based ABA Therapy
Center-based ABA Therapy
Community-based ABA Therapy
Speech Therapy
(Select all you would like to learn more about)
Additional Comments
How did you hear about us?
Scroll to Top