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Manual ABA Submissions
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First Name
*
Last Name
*
Phone Number
*
Email Address
*
Your Position
*
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CEO / Owner
Clinical Director
Senior Staff
BCBA
What's Your Biggest "Pain Point"?
Select An Option
RBT Staffing
BCBA Staffing
Billing & Coding
Intake Process
Practice MGMT Software
Insurance Approval
Cancelled Sessions
Referral Sources
Business Optimization
Rates & Contract Negotiation
Payer Mix
How Many Centers Do You Operate?
*
How Many Years Have You Been In Business?
*
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0-2 years
2-3 years
3-4 years
4-5 years
5+ years
Are You A Non-Profit or For-Profit Organization?
*
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Non-Profit
For-Profit
Location of Company Headquarters
*
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Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
How Many Other States Do You Have Practices In?
*
Do You Provide Services In Home Or In Center?
*
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In Home
In Center
Both
What Bracket Do You Fall In For Annual Revenue?
*
Under $2M
$2M-$4M
$4M-$6M
$6M-$8M
Above $8M
Number Of Patients?
*
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0-10 Patients
10-30 Patients
30-50 Patients
50+ Patients
Number Of Staff?
*
Average RBT Hours Per Patient?
*
How Would You Like Us To Contact You?
*
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Phone Call
Text Message
Email
Submit My Application!
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