ABA Services Survey Question Title * 1. Are you interested in ABA Services (Applied Behavior Analysis)? Yes No OK Question Title * 2. How old is your child seeking ABA Services 0-3 years 3.5-6 years 6.5-9 years 9.5-12 years 12.5-16 years 16.5-18 years 18+ OK Question Title * 3. Which insurance company provides your child's health insurance? Mass Health Blue Cross Blue Shield Harvard Pilgrim Tufts United Other (please specify) OK Question Title * 4. Does your child have supplementary insurance through Mass Health? Yes No OK Question Title * 5. Has ABA been deemed a medically necessary service for your child? Yes No Other (please specify) OK Question Title * 6. Is your child currently receiving the amount of ABA services prescribed? Yes No Other (please specify) OK Question Title * 7. If you would like us to contact you regarding ABA Services, please provide us with your email address and cell phone name email cell phone OK DONE