Quest Kids Therapy

Initial Inquiry for Services

Quest Kids Therapy

Initial Inquiry for Services

Inquire About Services Today!

Quest Kids Therapy has been providing high-quality ABA therapy services to families in the Central Florida region for over 20 years. We’d love to see how we can assist your family.

Currently, we accept Aetna, Cigna, CompPsych, Medicaid and United.

En Español

Learn More

Quest Kids Therapy Initial Inquiry Form

"*" indicates required fields

Parent/Guardian Info

Name*

First Last

Email*

Phone*

Opt-In for Text Communications*

Yes

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Relationship to Child*

Preferred Method of Communication*

Phone

Child Info

Name*

First Last

Age

Birthdate*

MM slash DD slash YYYY

Diagnosis*

Skills/Challenges for child to work on

Social skills

Communication

Potty training

Aggression

Self-injurious behavior

Eating

Following instructions

Safety awareness

Property disruption

Sensory issues

Additional info on your child's challenges

Male/Female

Male

Female

Insurance

Provider*

Aetna (For Aetna Better Health plan, please choose Medicaid)

Cigna

CompPsych

Medicaid (May have waitlist)

United

Other

Insurance Member #*

Insurance Phone #*

Script (Referral) for ABA Therapy Status*

Possess current script (referral) within one year of current date

Does not have current script (referral)

Comprehensive Diagnostic Evaluation (CDE)*

Possess CDE within 3 years of current date

Does not have current CDE

Currently have a CDE evaluation appointment

To expedite application, please upload both the Script and CDE below

Drop files here or

Max. file size: 512 MB.

Location Info

Primary Therapy Center Location Preference*

Lake Mary

West Orange

Winter Park (Near W Fairbanks Ave & I-4)

Tampa

In Home

In School

School Name*

School Location*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Secondary Therapy Center Location Preference (If applicable)

Lake Mary

West Orange

Winter Park (Near W Fairbanks Ave & I-4)

Tampa

In Home

In School

School Location*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Preferred Availability

Mornings

Afternoons

Full days

Open/Any

How many hours of ABA therapy are a week are you seeking with Quest?*

10 hours or less

11-15 hours

16-20 hours

20+ hours

How did you hear about us?*

Word of Mouth

Google Search

Facebook

Instagram

Mailed Postcard

Physician referral

Other

Please tell us the name of the referring physician*

Please explain

Once you click the "Submit" button, you should see a page that says, "Thank You! We will be in touch soon to discuss your application." If you do not see that, please scroll down as you may need to correct a required field. Thank you.

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Contact Quest Kids Therapy

We’d love to talk with you about how Quest can improve your child and your family’s life. Feel free to reach out by email, phone or submit an initial application. Thank you for considering Quest!

Orlando Region:

407.218.4345

Tampa Region:

Programs

Residential Services

Employment Services

Training Centers

Quest Kids Therapy

Quest Kids Academy

Quest’s Camp Thunderbird

Quest Village

Blossom

If you have a hearing impairment and require the services provided by TTY/TDD, please dial 711.

Quest Kids Therapy

Quest Kids Therapy

Inquire About Services Today!

Quest Kids Therapy Initial Inquiry Form

Parent/Guardian Info

Child Info

Insurance

Location Info

Contact Quest Kids Therapy

Orlando Region:

407.218.4345

Tampa Region:

813.423.7740