Get Started

Reach out today to see if LifeSpeed is the right fit for you and your family.

4 Simple Steps

These are the key steps that must be accomplished prior to the start of ABA services.

Once completed, the assigned BCBA will introduce you to the team of Therapists who will begin working directly with your family to achieve the goals outlined in the Treatment Plan.

Intake Form
Complete an Initial Intake Form below and our Client Services Coordinator will contact you.

Phone Screening
We verify private insurance benefits, coordinate HCBS Waiver funding, and schedule an in-person follow-up meeting at a mutually convenient location.

Intake Meeting
A team member will meet with your family to clarify expectations, answer questions, discuss goals, and review the terms of our ABA Service Agreement & Consent.

Assessment & Plan Development
The BCBA will conduct a Functional Behavior Assessment, consisting of interviews, observations, and skill probes; a Treatment Plan will be created based on caregiver goals and client input.

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Client First Name*

Client Last Name*

Client Date of Birth*

Parent/Guardian Name(s)*

Parent/Guardian Email*

Parent/Guardian Phone*

Address*

Street Address Address Line 2 City ZIP / Postal Code

What Service Are You Interested In?*

Funding Source

Who is the diagnostic practitioner?*

How did you hear about us?*

Client's Diagnoses*

Presenting Concerns*

Current Medications and Dosages (e.g., Lexapro, 10mg per day administered in the AM)*

Select Day For An Intake Meeting:*

Time*

Select Alternative Day For An Intake Meeting:*

Alternative Time*

Please Upload Both Front/Back of Your Insurance Card*

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Consent*

I agree to the ABA Service Agreement & Consent policy.

Consent for Services This document contains significant information regarding the Applied Behavior Analysis (ABA) services provided by LifeSpeed: Behavioral Support Services, LLC (LifeSpeed). It outlines service details, costs, responsibilities, and policies. Please review this information carefully before proceeding.
By checking this box, you acknowledge and agree to the following:
Service Agreement: You understand that LifeSpeed will provide ABA services to the person you are authorized to consent on behalf of (the Client).
Financial Responsibility: You acknowledge that you are responsible for:
- Any services not covered by your insurance provider (if applicable).
- Co-payments and deductibles.
- Any costs associated with collecting outstanding balances owed to LifeSpeed.
Right to Withdraw: You and the Client (if applicable) have the right to discontinue services at any time without penalty, except for any outstanding payments due.
Compliance with Ethical Standards: LifeSpeed follows the Behavior Analyst Certification Board (BACB) Professional and Ethical Compliance Code for Behavior Analysts. A copy of this Code is available at: BACB Compliance Code
Outline of Services:
- ABA services are available for children, adolescents, and adults who require behavioral support.
- LifeSpeed will offer referrals to other professionals if necessary.
- Services include the development of an Individual & Family Treatment Plan (IFTP) centered on ABA principles.
- ABA services will be carried out by a Board Certified Behavior Analyst (BCBA), Board Certified Assistant Behavior Analyst (BCaBA), Registered Behavior Technician (RBT), or a highly trained Behavior Therapist under the direct supervision of a BCBA.
- The IFTP will use evidence-based strategies to increase meaningful and rewarding experiences for the Client.
Caregiver/Guardian Participation: Active involvement in the ABA process is required, including attending support meetings, collecting data, and implementing strategies.
Confidentiality and HIPAA Compliance: LifeSpeed follows HIPAA guidelines to protect Client information, except in cases where reporting is legally required, such as suspected abuse or self-harm.
Mandated Reporting: LifeSpeed employees are required by law to report any suspected child abuse, neglect, financial exploitation, or self-neglect of vulnerable individuals.
By checking this box, you confirm that you have read and understood this agreement and consent to ABA services provided by LifeSpeed.