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What is your Zip Code?
What is your Child's date of birth?
What is your Child's date of births?
What is your child's first and last name?
What is your child's gender
Prefer not to say
Has Your Child Been Diagnosed With Autism?
I Don't Know
Who Is Your Insurance Provider?
Beacon Health Options
Blue Cross Blue Shield
CMS Title 19 (Medicaid)
CMS Title 21 (Not Medicaid)
United Behavioral Health
I do not have Health Insurance
What is the date of birth for the primary insurance subscriber?
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+1 (305) 597-3861
9600 NW 25th st, Suite PH, Doral, FL 3172