Get Started with one of our ABA Programs
Fill out a request for services form

To explore possible enrollment in any of our ABA programs, complete the Request for Services form and submit it to our office. This allows our clinical staff to quickly gather information about your child or teen so we can efficiently answer your questions and give you a recommendation on which services should be provided to meet your child’s individualized needs.

Please fill out this form in its entirety. Upon receipt of your completed form, we will contact you within one to two weeks to further discuss our services and program philosophy.

Autism Partnership
200 Marina Drive
Seal Beach, Ca 90740
(562) 431-9293 Ext 110
Fax ((562) 431-8386
Reason(s) for filling out Request for Services Form
Tell us about your family
years old
Service information
Funding information
Current Services that are being Provided

ABA at home or school, Speech, OT, etc.

School Information
Additional information
1081612701815743 » If you have a visual disability, please type the numbers two one three three into the box. Your submission will be promptly reviewed by a validation service and sent to the site administrators.
By proving you are not a machine, you help us prevent spam and keep the site secure.