Welcome to Peak Behavioral Services!

We are happy to be your child's ABA, Speech, and Occupational Therapy provider of choice. Please fill out our intake form below to ensure timely coordination of services for your child.

If you have any questions, please contact us at (630) 632-4350 or intake@peakbehavioralservices.org.

Child's Full Name

First Name

Last Name

Date of Birth

YYYY

Parent or Legal Caretaker's Full Name

First Name

Last Name

Phone Number

(###)

###

####

Parent's Email

Insurance Provider

Is your child diagnosed with Autism?

Does your child have any allergies?

Is your child enrolled in school?

What program would you like your child to attend?

Welcome to Peak Behavioral Services!

Thank you! One of our dedicated team members will reach out shortly.

Our Locations: