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What is your Zip Code?
What is your Child's date of birth?
What is your child's first and last name?
What is your child's gender
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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