Send us a referral and we take it from there — intake, benefits, authorization and a report back to you.
We welcome referrals from physicians, schools and families. Send the diagnosis you have — confirmed or still being evaluated — and we tell you whether ABA is covered.
Primary care physicians identifying developmental concerns
Specialists providing neurological diagnoses and evaluations
Licensed professionals conducting psychological assessments
Educators and school counselors supporting student needs
Parents and guardians seeking ABA services directly for their child
Form AIMH-FRM-040 · v1.1
Every copy gets its own reference number, printed at the bottom of both pages, so two referrals are never confused. Fill it on screen, sign it, and send it back without printing anything. Or fax it to (786) 388-0516.
Type straight into the form on screen, sign it, and we build the signed PDF for you. It works on a phone. This is the quickest way.
Prefer the PDF? The three steps below still work.
Press the button. We issue a reference number, stamp it on both pages and the form downloads.
Plain copy, no numberYour reference number
Write it down. It is printed at the bottom of both pages and it is already filled in below.
Open this copy in a new tab to fill it →
The fields are typeable in Chrome, Edge, Firefox, Safari and Preview, and in Adobe Acrobat Reader. Complete both pages and save the file — in Chrome that is the download icon inside the PDF viewer, not the browser’s print button.
A referral is complete with the prescription, the diagnostic evaluation (or “evaluation needed” checked) and the insurance card. Send those in step 3 as well.
If your office prefers email, press the button: it opens your mail program with the address, the subject and the body already written. You then attach the PDF you saved, plus anything else.
This is what will be sent:
Email cannot attach the file for you — no website can. Attach the PDF you saved before you press send. If the address is not one of ours, we cannot guarantee the message reaches intake.
Complete the form below to refer a patient. Our intake team will follow up within 24–48 hours.
Our intake process is designed to be simple and stress-free for families.
Our intake coordinator reaches out to the family within 24–48 hours to introduce our services, answer questions, and begin the onboarding process.
We verify the family's insurance benefits and handle all prior authorization paperwork so ABA therapy can be covered with no out-of-pocket costs where applicable.
Once authorized, we schedule a comprehensive behavioral assessment with a BCBA to develop an individualized treatment plan tailored to the child's needs.
Our team is ready to guide you through the referral process and answer any questions.
(786) 652-6945
info@americaninstituteofmentalhealth.com
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