ABA therapy

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Contact Us

Get in touch

Schedule a free consultation

Home
About
Parents Resources
- Therapy Services
Career
- Continued Education
Contact Us

NEW CLIENT INTAKE FORM

CONTACT FORM

Parent/Guardian Name:

Last Name

Email:

Phone:

How did you hear about us?

Google Search

Friend/Family Referral

Instagram

Other

Child Name:

Last Name:

Age:

Current Diagnosis:

Preferred Consultation Type

Tell us about your chidl's needs and goals:

Any specific questions you'd like us to address?:

What services are you interested in?

ABA Therapy

Speech & Language Therapy

Occupational Therapy

Services in the Home Setting

Services in the School Setting

Services in the Daycare Setting

Preferred Contact Method

Phone

Email

Text

WhatsApp

Thank you for contacting us.

We will get back to you within 24 hours.

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786-403-2245

Free Consultation

Mon-Fri: 9:00 am - 5:00 pm

Serving Miami-Dade County

Home-based Services

School-based Services

Clinic-based Services (coming soon)

info@selflc.com

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