Client Intake Form

Please complete the information below and a member of Bright Horizons Academy will contact you within 1 or 2 business days. Thank You!

Some information may be required for Pre-Authorization from your insurance company including:

• Copy of Autism Diagnostic Paperwork (If you have BCBS or BCN insurance, a diagnosis from an Approved Autism Evaluation Center is needed.

• Copy of your Insurance Card

• Current Individualized Education Plan (IEP If Applicable)

• Custody agreement if parents are divorced

• Guardianship documentation (If Applicable)