Wellspring Learning Centers
If you are interested in making an ABA referral, we have outlined the necessary information below to help guide you through the process. Here are our referral order requirements. Please email us at firstname.lastname@example.org or fax us at (615) 216-9773 with the completed ABA referral order.
- Contact Information
Please provide us with your office contact details, including phone number, email address, and fax number.
- Patient Information
Please include the name, age, gender, and any specific diagnoses your patient has that may be relevant to their treatment. Also, include the contact information of the caregiver.
- Insurance Information
Please include your patient’s insurance details, including the insurance provider, policy number, and any applicable authorizations or pre-approvals. If funding will be provided through sources other than insurance, please provide relevant information, such as Medicaid, state-funded programs, or private payment arrangements.
- Relevant Documentation
To ensure a comprehensive understanding of your patient’s needs, we kindly request any relevant documentation, including previous assessments, treatment plans, and diagnostic reports. These documents enable our team to create a tailored ABA therapy plan that addresses specific goals and targets the areas requiring intervention.