What is ABA?

Service Application

Thank you for your interest in Vantage Group Inc.'s Autism Program.

The below information will assist our team in verifying your insurance benefits and obtaining necessary authorizations to begin services.

Please complete each section to the best of your ability.

For items not relevant to you or your loved one, simply notate "N/A".

If you have any additional questions please contact the Director of Autism Services, Michelle Covert, at 203-234-7737 or mcovert@vantagegroupinc.org

We look forward to working with you and your family!


Fax: 203-793-7817

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Vantage Group, Inc. 29 North Plains Highway Unit 15, Wallingford, CT 06492