Check Your Insurance Coverage

Complete our eligibility verification form to confirm benefits and discuss next steps.

Note: Autism diagnosis (F84.0) is required for medical ABA coverage.

Child Information

First Name *

Last Name *

Date of Birth *

Diagnosis of Autism? *

Parent/Guardian

Full Name *

Relationship to Child *

Phone *

Email *

Address

Street Address *

City *

State *

ZIP Code *

Insurance Information

Insurance Carrier *

Member ID *

Group ID (Optional)

Policy Holder Name *

Policy Holder DOB *

Policy Holder Relationship *

Services & Scheduling

Preferred Setting *

Preferred Days *

MondayTuesdayWednesdayThursdayFridaySaturday

Preferred Times *

MorningsAfternoonsEvenings

How did you hear about us? (Optional)

Additional Notes (Optional)

Consent

I consent to be contacted about ABA services. *

I understand eligibility is not a guarantee of coverage. *

I agree to the privacy policy. *

Educational and Developmental Therapies (EDT) provides ABA therapy, assessments, and parent training for children with Autism and ASD in the Bay Area.

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Contact

Phone: 1-831-600-6217

Email: admin@abaedtherapies.com

Email: klaitinen@abaedtherapies.com

Locations

400 South Monroe St., San Jose, CA 95128

10096 Soquel Dr., Suite A, Aptos, CA 95003