For Pediatricians, Schools & Partners

Thank you for considering us for your patients and students. American Institute of Mental Health provides BCBA-led Applied Behavior Analysis for children with autism across Miami-Dade, Broward, Palm Beach and Monroe counties. We manage insurance verification, authorizations and reporting so your team does not have to.

📄 Submit a referral online 🖨️ Printable referral sheet 📞 (786) 652-6945

Practice information

How the referral works

1. You send the referral — online form, fax, email or phone. Minimum: patient name, date of birth, guardian contact and diagnosis.
2. We contact the family within one business day and explain the process in their language.
3. Free insurance verification. Our billing team confirms ABA coverage and prior-authorization requirements.
4. BCBA assessment. Standardized tools (VB-MAPP, ABLLS-R, AFLS) plus direct observation and caregiver interview.
5. Authorization and start of care. We submit the plan, follow up with the payer and begin sessions once approved.
6. You get updates. With guardian consent, we send you the assessment summary and progress reports for your records.

What to include with a referral

• Prescription or order for ABA listing the ASD diagnosis and ICD-10 code (F84.0)
• Diagnostic evaluation or CDE, if available
• Letter of medical necessity, if your practice issues one
• Insurance card copy or plan and member ID
• IEP or school evaluation, when the child attends public school (helpful, not required)
• Guardian name, phone, email and preferred language

Do not have everything? Send what you have — our intake team follows up with the family for the rest.

For schools and community partners

ABA is a medical service and does not replace the supports in a student's IEP — the two work best together. With guardian authorization, our BCBAs coordinate with school teams so strategies, communication systems and expectations stay consistent between the classroom and home.

We can provide in-school support, staff consultation and observation, subject to district agreements. To discuss a partnership, email management@americaninstituteofmentalhealth.com.

🖨️ Printable referral sheet

Print this page section and keep it at the front desk, or fax the completed sheet to (786) 652-6931.

American Institute of Mental Health Inc.
ABA Referral Form · NPI 1780307678 · Fax (786) 652-6931 · Phone (786) 652-6945

PATIENT
Name: ______________________________ DOB: ____________ Sex: ______
Diagnosis / ICD-10: ______________________________ Date of diagnosis: ____________

GUARDIAN
Name: ______________________________ Relationship: ______________
Phone: __________________ Email: ______________________________
Preferred language: ☐ English ☐ Spanish ☐ French ☐ Haitian Creole

INSURANCE
Plan: ______________________________ Member ID: __________________
Policy holder: ______________________________

REFERRING PROVIDER
Name: ______________________________ NPI: __________________
Practice: ______________________________ Phone: __________________
Signature: ______________________________ Date: ____________

ATTACHED ☐ Prescription ☐ Diagnostic evaluation / CDE ☐ Medical necessity letter ☐ Insurance card ☐ IEP

Fax to (786) 652-6931 or email intake@americaninstituteofmentalhealth.com · americaninstituteofmentalhealth.com/referrals

Ready to refer?

The online form takes two minutes and lets you attach documents securely.

📄 Submit a referral ✉️ intake@americaninstituteofmentalhealth.com