PHYSICIAN REFERRALS

If you are a physician, nurse practitioner, or any other medical professional who has a patient who you'd like to refer to CCBT for ABA therapy services, please download our referral form below. Completed referral forms should be faxed to (833) 409-2205.
Please include the patient's autism diagnosis documentation (if available) and a prescription or service order for an ABA therapy evaluation.
If you have any questions, please contact us at (937) 441-1782.