Referral and intake documentation

Please complete and attach referral for ABA services (either using provided template or in-house template), Release of Information (If available), and feel free to access intake paperwork documents provided for reference.

Medical Necessity (pdf)Download

Client Release of Information - English (pdf)Download

New Client Paperwork Fillable (BLANK) (pdf)Download

New Client Paperwork - Consent Forms Fillable (pdf)Download

For Medical professionals: refer a client for care

Please Complete the Following to Refer Client to Blue Skies (responses sent to confidential mailbox)

Name of Referring Provider:*

Practice / Location: *

Email*

Client Name: *

Diagnosis or NA:*

Client Age: *

Parent Contact Email:

Language(s) Spoken: *

Parent Contact Phone:

Attach ROI or Referral if Avai

Attachments (0)

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What Happens Next?

We will do our best to reach out to families within 48 hours of initial contact and referral.

Please note: clients must have a formal ASD Diagnosis to receive ABA services for all funders except Medicaid.

Blue Skies Behavioral Group

Phone: 719-839-0552 Fax: 970-406-5012

Now Hiring!

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