Get Started

Request ABA Services

Begin by completing the brief service inquiry below.

Questions before you begin?
info@empoweredjourneysaba.com (352) 852-2942

For general questions only—please do not email medical records, insurance information, or other sensitive documents.

Two parents and their young child drawing together on the floor at home.
Step 1 — Initial Inquiry

Service Inquiry

Complete this brief inquiry so we can learn about your child, determine whether our services may be appropriate, and contact you about next steps.

Please do not include medical records, diagnostic reports, insurance card details, or other documents in this form. We’ll collect those separately later if appropriate.

Caregiver Information

Preferred Contact Method *

Child Information

We do not ask for your child’s full street address at this stage — that’s collected later during client intake.

Services

What type of services are you interested in? (optional — select all that apply)
What days and times are you generally seeking services? (optional — general availability is fine)

Diagnosis

Does your child currently have a diagnosis of Autism Spectrum Disorder (ASD)? *

Insurance / Funding

How do you plan to pay for services? (optional)

Current ABA Services

Is your child currently receiving ABA therapy? (optional)

Safety Screening

Asked so we can prepare appropriately for your family’s needs — this question is optional.

Are there any significant safety or behavioral concerns that may affect service delivery? (optional)

Please don’t describe specific behaviors here — we may follow up for clarification before moving forward.

Referral Source

Contact Permission

What Happens After You Submit

We Review Your Inquiry

We review your information, service needs, location, scheduling preferences, and current availability.

We Contact You

We contact you to discuss your family’s needs, answer initial questions, and explain whether our services may be appropriate.

Next Steps

When appropriate, we provide instructions for intake, benefits verification, assessment authorization, and scheduling.

Are You a Professional Making a Referral?

Visit our dedicated referral page for what to send us and how to reach our team.

Refer a Client