Get Started | One of the Kids

Name of Child

Name of Parent/Insured

Phone

Date of Birth

Relationship

Email

Street Address

City, State, Zip

Name of Pediatrician

Primary Health Insurance Company

Group ID

Insurance Phone Number (on card)

Diagnosis for Autism Spectrum Disorders?

Insurance Member ID (for verification of benefits)

Employer (associated with primary health insurance)

Who referred you to us?

Comments

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One of the Kids • 2105 East Park Street, Cedar Park, TX 78613