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REGISTRATION LIST

INTAKE PROCESS/AUTHORIZATION LIST

Authorization List Process

Please review the checklist below and gather all required information before proceeding to fill out the intake registration form.  You will be contacted once your registration information is reviewed or if any further clarification is needed.  Once your information has been verified, you will be added to our authorization list.

ITEMS WE'LL NEED UPLOADED

Please gather the following information before filling out your intake registration form:

  • Insurance card (front and back)

  • Letter of medical necessity

  • Policy owner Id

  • Child's current psychological evaluation (within 3 years)

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