Voorhees Center

New Client Inquiry Form

Please click on “New Client Inquiry Form” above and fill this out so that a member of our team can reach out to you promptly regarding the Voorhees clinic and any questions you might have.

If you have no further questions, please apply below if you would like to proceed forward with joining our center!

Apply Here

Voorhees Center Full Time/Part Time Application for individuals with Special Needs.

Parent/Guardian Name:(Required)

Relationship to child:(Required)

Phone Number:(Required)

Email Address:(Required)

Home Address:(Required)

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Secondary Parent/Guardian Name (if applicable):

Relationship to child:

Home Address (if different):

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Phone Number:

Email Address:

Child's Full Name(Required)

Date of Birth:(Required)

Any Behavioral Concerns or Special Instructions:

Diagnosis (if applicable)

Policyholder’s Date of Birth:

Policyholder’s Name:

Relationship to Child:

Primary Insurance Provider:

Policy Number:

Group Number:

Insurance Provider Phone Number:

Program Preferences(Required)

Full-Time Only

Full-Time + Aftercare

Part-Time (hours are costumized)

If Part-Time, Drop-Off Time Preference:

Morning

Afternoon

Payment Type:(Required)

Private Pay

Insurance

Combination

Additional Information:

New Client Inquiry Form

Please click on “New Client Inquiry Form” above and fill this out so that a member of our team can reach out to you promptly regarding the Voorhees clinic and any questions you might have.

If you have no further questions, please apply below if you would like to proceed forward with joining our center!

Apply Here

Get the Individualized Autism Care Your Child Needs

Get the Individualized Autism Care
Your Child Needs