New Client Application - Action Behavior Centers

New Client Application Form

Thank you for visiting our website and your interest in getting in touch.

Action Behavior Centers are an elite chain of Texas-based providers of ABA therapy services for children on the Autism Spectrum. We are committed to helping children reach their full potential.

By completing our New Client Application form, you are only indicating an interest in our services, but not making any obligation, contract, or establishing a provider-patient relationship. If you provide the below information, it will help us to schedule an appointment for your child. Our goal is to be in touch with you within one business day.

If you have any questions, please contact the center you’re most interested in or use the chat feature (at the lower right corner of our website).

New Client Application Form

Name of Child for Services

First Last

Date of Birth of Client*

Name of Parent/Insured*

First Last

Relationship to Client*

Phone*

Email*

Address

Street Address City State ZIP Code

Name of Pediatrician

Diagnosis for Autism Spectrum Disorders?*

Primary Health Insurance Company*

Insurance Member ID (for verification of benefits)

Insurance Group ID

Employer (associated with primary Health Insurance)

Insurance Phone Number (on card)

Preferred Location*

Hidden

Lead Source

Hidden

utm_source

CAPTCHA

Name

This field is for validation purposes and should be left unchanged.

Action Behavior Centers respect your privacy, protected health information and contact information. We will not, without your permission, share this information with unauthorized outside parties.

Other ways to contact us

Please reach out to chat with our friendly team members. We would love to meet with you and give you a tour of the facility which interests you most. Fill out a New Client Application form today, and one of our staff will be in touch shortly.

Contact Details

Austin Center

2100 Kramer Lane
Suite 150
Austin, Texas 78758

Phone:
(512) 572-0157

Email:
Info@ActionBehavior.com

Our Hours
M-F: 8am to 5:30pm
Closed weekends

Round Rock Center

15930 Great Oaks Drive
Building B
Round Rock, Texas 78681

Phone:
(512) 460-1950

Email:
Info@ActionBehavior.com

Our Hours
M-F: 8am to 5:30pm
Closed weekends

Spring Center

9316 Louetta Road
Spring, TX 77379

Phone:
(713) 962-4599

Email:
Info@ActionBehavior.com

Our Hours
M-F: 8am to 5:30pm
Closed weekends