Make an Appointment

To help you understand the new client intake process, please read below:

*  We request that all new client inquiries be sent via the FORM below so that we have all of the information required to ensure that you are scheduled for the appropriate service and the provider that can best meet your needs.

*  Please understand that the Executive Director and Assistant Director personally review each new client inquiry to better understand your clinical needs and to match your case with the most appropriate provider.  Administrative meetings occur twice a week to allow for new client case reviews and assignments.Dependent upon the day of your submission in relation to the timing of the next administrative meeting, please expect a reply from the intake coordinator within 2 to 5 business days.  For your convenience, the intake coordinator will respond VIA EMAIL, unless you specifically decline consent for email correspondence.  Again, please check your spam box if you do not receive an email within this time frame. At times the intake coordinator will also reach out VIA PHONE; please be sure to check your voicemail regularly. 

*  If you do not hear from the intake coordinator within the time-frame above, PLEASE EMAIL INFO@BEACONPEDIATRIC.COM TO FOLLOW UP. You are welcome to contact us via phone at any time; however, if no one is available to take your call, it is important that you leave a detailed message, including preferred call back times. We do not have a full time receptionist on site, thus you are likely to receive a quicker response, via email. 

 
Your Name *
Your Name
Child's Name *
Child's Name
Child's Date of Birth *
Child's Date of Birth
Preferred Method of Communication *
Please check all that apply; by marking your selection, you consent to BPBH sending you appointment information via the selected method
Phone *
Phone
Address *
Address
Please select which insurance you will be using. If it is not listed here, unfortunately, we do not accept your plan.
Please type in the ID number on your card; if you will be paying out of pocket simply write N/A
Please describe your current concerns/the types of services you are interested in.
ABA THERAPY: *
Please check next to ALL that apply. If you are not seeking ABA therapy, please simply check the first box.

Please keep in mind that communications via email and over the internet are not secure. Although it is unlikely, there is a possibility that information you include in an email or online form can be intercepted and read by other parties besides the person to whom it is addressed. By completing this form, you are confirming that you understand this and consent to communication with Beacon Pediatric Behavioral Health via email and over the internet.