Insurance Required Documents
Please download and print each documents in color. If you have questions regarding what forms to complete, please contact our office at (916) 364-7800.
Consent for Medically Necessary ABA Treatment
Member Responsibility Agreement Form
Consent to Exchange Information
Credit Card Authorization Form
Coordination of Benefits (Cigna clients only)
Authorization to Disclose Protected Health Information to PCP (Magellan clients only)
Please mail in the completed forms to:
4540 Harlin Drive
Sacramento CA 95826