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Girl at the Pediatrician

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.

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© 2021 by Collaborative Care Behavioral Therapy, LLC.

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