Please fill out our online form to schedule an intake meeting.We look forward to hearing from you.———Office: (714) 403-8186 Fax: (855) 719-3133 Email: Ronni.Clark@IndependenceABA.com Name * First Name Last Name Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### Email * Preferred method of communication Phonecall Text Email Insurance Provider Tricare West Health First Colorado Other Has your learner participated in ABA services before? * Yes No What is your previous experience with ABA? Open availability for therapy Please list times, days Thank you so much for submitting your intake, a staff member from Independence ABA will be in touch with you in 48-72 hours.