Get Started at DASI

Learn more about DASI by submitting the Initial Intake Form or begin the enrollment process by filling out the Registration Form.

Request an information packet

Please fill out the brief form below and a member of our team will reach out to answer questions and provide more information.

Your Name
First Last
Child's Name
First Last
Has your child been diagnosed with autism?*
- Yes
- No
Email*

What's the best email to reach you at?
Phone*
What's the best number to reach you by?
Address*
Street Address Address Line 2 City State ZIP Code
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)
How did you hear about us?
How can we help?
Preferred method of communication?
- Phone
- Email
(Check all that work for you)

Ready to Begin the Enrollment Process? Fill out the Registration Form

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*
Has your child received a diagnosis of Autism?*
- Yes
- No
Father's Name
First Last
Father's Date of Birth*
Mother's Name
First Last
Mother's Date of Birth*
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 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?

Quick Links

Get Started at DASI

Request an information packet

Ready to Begin the Enrollment Process? Fill out the Registration Form