Verify My Benefits for Autism Therapy

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Verify Benefits

First and Last Name of Client*

Client Date of Birth

Client Gender

Current Insurance

Known Allergies

Previous Therapy History

Primary Care Physician

Behaviors of Concern

Copy of insurance (front/back)

File(s) size limit is 20MB.

Guardian First Name*

Guardian Last Name*

Guardian's Email*

Mailing Street

Other Street

Mailing City

Mailing State

Mailing Zip

Guardian's Mobile

Guardian's Work Phone*

Guardian's Home Phone*

Fast Track ABA Center – Corporate Mailing Address
22720 Morton Ranch, Suite 160 – Katy, TX 77449
(713) 425-4248

Fast Track ABA Center
1118 Minonite Rd
Richmond, TX 77469
(713) 425-4248

Fast Track ABA Center
423 Mason Park Blvd.
Suite A
Katy, TX 77450
(281) 944-9608