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PEDIATRICTHERAPYSUPPORT
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About
What is ABA?
Services
Comprehensive assessment
School-based ABA Services
Home- based ABA Services
Parent Training
Diagnostic & Treatment
What is Autism?
What is Global Developmental Delay?
What is Oppositional Defiant Disorder?
What is Cerebral Palsy?
What is ADHD?
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Reference Form
Patient's First name
Patient's Last name
Email
Phone
DOB
Street Address
Street Address Line 2
City
Region/State/Province
Postal / Zip code
Country
Country
Child's diagnosis (please check all that apply)
Autism
Learning Disability
Aggression
Tantrums
Failure to comply with instructions
Ritualistic behaviors
Pica/mouthing
ADHD
Anxiety
Learning Disability
Stereotypes
Self-injurious behaviors
Impulsivity
Inattention
Tantrums
Hyperactivity
Sensitive to change
Inability to stay organized
Interpersonal relationship dysfunction
Ritualistic Behaviors
Oppositional / Defiant Behavior
Property destruction
Setting (choose one or more)
Home
School
Community
Availability (choose one or more)
Mornings
Afternoons
Evenings
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