Autism Therapy Referral & Client Intake Portal

To expedite the clinical review and insurance authorization process, please download, sign, and upload these forms alongside the referral sheet.

Complete family contacts, child developmental details, and medical records history.

Download PDF

Grants CATC explicit permission to communicate directly with child's primary clinicians.

Download PDF

Request daily medical transportation support for center-based clinical programs.

Download PDF

Digital Referral Form

Fields marked with a red asterisk (*) are required.

Referrer's First Name *

Referrer's Last Name *

Referrer's Email Address *

Referrer's Phone *

Is an interpreter needed? *

Reason for Referral & Observed Behavior *

Parent's First Name

Parent's Last Name

Parent's Email

Parent's Phone

Manager's First Name

Manager's Last Name

Manager's Email

Manager's Phone

Select all that apply:

Center-Based ABA Family Skills Coaching Tele-Health Guidance

Do you have medical assistance / healthcare coverage?

Yes, Active Coverage No Coverage

Clinical Assessments / Medical Reports (if any)

Click to upload assessment or diagnostic report

Accepted: PDF, DOC, DOCX (Max 512MB)