Get Started | Ultimate Caring ABA Dallas

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Family & Child Information

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We've Received Your Information

Thank you for reaching out to Ultimate Caring ABA. A member of our team will contact you within one business day to discuss next steps. We look forward to partnering with your family.

Parent / Guardian

First Name *

Last Name *

Phone Number *

Email Address *

Best Time to Contact

Preferred Contact Method

Home Address (City, State, ZIP)

Child / Client Information

Child's First Name *

Child's Last Name *

Date of Birth *

Age

Gender

Primary Diagnosis

Additional Diagnoses or Relevant Medical History

Current Services / Therapies (if any)

Insurance Information

Insurance Provider *

Member / Policy ID

Group Number

Insurance Holder Name

Insurance Card Photos (optional but speeds up verification)

Upload a photo of the front and back of your insurance card. This helps us verify your coverage faster — no waiting on hold.

Front of Card 📷 Tap to upload JPG, PNG or PDF

Back of Card 📷 Tap to upload JPG, PNG or PDF

🔒 Your documents are transmitted securely and used solely for insurance verification purposes.

Services You're Interested In

In-Home ABA Therapy

Family Counseling

Parent Training

Caregiver Support

School / Day Care Based Therapy

Life Skills Therapy (Older Kids & Teens)

Center-Based Therapy (Coming Soon · Collin County)

Not Sure — Need Guidance

Referral Information

How did you hear about us?

Referring Provider Name (if applicable)

Anything else you'd like us to know?

Your information goes directly to admin@ultimatecaringaba.com
A member of our team will respond within 1 business day

Rooted in Care.

Partners in Healthcare
for the Entire Family

Let's Get Your FamilyStarted on the Journey

Family & Child Information

We've Received Your Information

Let's Get Your Family
Started on the Journey