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Can we help you find services for autism therapy?

Please take a few minutes to answer this survey

The survey should take no more than 5 minutes to complete.

STEP 1 of 4: Child Information

Contact us to learn how Bright Horizons has helped families and kiddos living with autism:

Child First Name *

Child Last Name *

Child Date of Birth *

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STEP 2 of 4: Services Requested

Contact us to learn how Bright Horizons has helped families and kiddos living with autism:

Primary Language of Child *

Autism Therapy Services

ABA

Diagnostic Services

Therapy Location Preference *

Does your child have formal diagnosis of autism? *

Upload copy of autism diagnosis (PDF)

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What is a valid diagnostic report?
– Completed by a Qualified Healthcare Professional (for example, but not limited to: PsyD, MD)
– Gives a diagnosis of F84.0 – Autism Spectrum Disorder
– Contains standardized testing, such as ADOS-II, ADI-R, CARS, GARS, STAT, BASC
– Full report details including social history (not just one-page summary)
– Completed within the last 3 years

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STEP 3 of 4: Primary Contact

Contact us to learn how Bright Horizons has helped families and kiddos living with autism:

Guardian’s First Name *

Guardian’s Last Name *

Phone Number *

Contact Email *

Preferred Method of Contact *

By submitting this form, you agree to receive recurring automated promotional and personalized marketing text messages (e.g. appointment reminders) at this number from Bright Horizons. Consent is not a condition of any services. Reply HELP for help and STOP to cancel. Msg frequency varies. Msg & data rates may apply. View Terms and Privacy Policy.

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STEP 4 of 4: Primary Insurance and Care (?)

Contact us to learn how Bright Horizons has helped families and kiddos living with autism:

Insurance Type *

Insurance Company - AZ *

Insurance Plan

Insurance Member ID # *

Doctor Last Name

Practice Name

Practice Phone

Was your child referred by your primary Physician? *

By submitting this form, you agree to receive recurring automated promotional and personalized marketing text messages (e.g. appointment reminders) at this number from Bright Horizons. Consent is not a condition of any services. Reply HELP for help and STOP to cancel. Msg frequency varies. Msg & data rates may apply. View Terms and Privacy Policy.

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Thank You!

Thank you for contacting us.

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Can we help you find services for autism therapy?

STEP 1 of 4: Child Information

STEP 2 of 4: Services Requested

STEP 3 of 4: Primary Contact

STEP 4 of 4: Primary Insurance and Care (?)

Thank You!

1 in 36 children is diagnosed with autism, according to the CDC’s latest data (2024)

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