Child's Name: *

Phone *

Subject: *

Our address is 2912 Warren Ave, Lake Charles, LA 70601

Name: *

Child's DOB:

Upload Comprehensive Diagnostic Evaluation

Name of legal guardian (s): *

Child's Diagnosis: *

Message: *

Upload IEP

Email: *

Check here to receive email updates

Email: *

Check here to receive email updates

Please briefly describe your child and your concerns *

Upload Insurance or Medicaid card

Primary Insurance *

Secondary Insurance

Registration Form

Comments/Questions:

Referrals can be faxed to us at (337) 210-7061 or emailed to us at info@behaviorir.com

Locate us

Like us on Facebook!

Behavior Intervention Resources, LLC

An ABA Therapy Provider

for SWLA

​Behavior Intervention Resources, LLC