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Dream Team Behavioral Services

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Enrollment

Please Note: This form is NOT a consent for services. It is used as an initial point of contact which allows you to receive more information and determine if Dream Team Behavioral Services is the right choice for you.

Client's First Name

Client's Last Name

Caregiver First and Last Name

Client's Date of Birth

Caregiver Email Address

Caregiver Phone Number

Please select the service/services you are interested in

ABA Therapy

ABA Tutoring / Shadow Services

ABA Workshops

Social Skills

Caregiver Training

I'm not sure. I just want more information.

Client Insurance

Today's Date

I declare that the info I’ve provided is accurate & complete

Thank you for your interest ! You will receive a follow up email within 3 business days.

Dream Team Behavioral Services, LLC

Meet Our Donors

Servicing Miami, FL

Behavioral Issues

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