Have a Family Who Needs Services?

Provider Referrals

Thank you for considering Hickory Learning Group for your patient's care.

To refer a patient for Home and Community-Based Applied Behavior Analysis (ABA) Services, please download and complete our ABA Service Order Referral Form.

A complete referral includes:

• Completed ABA Service Order Referral Form

• Patient's full name and date of birth

• ICD-10 diagnosis code (e.g., F84.0 – Autism Spectrum Disorder)

• Referral for Evaluation and Treatment for Applied Behavior Analysis (ABA) Services

• Visit notes supporting the diagnosis and medical necessity for the referral

• Referring provider's name, practice name, phone number, fax number, and NPI number

• Signature and date from an approved referring provider (MD, DO, Ph.D., or Psy.D.)

Once completed, please fax the referral form and supporting visit notes to (828) 738-1651 or email us at info@hickorylearninggroup.org

If you have questions about the referral process or need additional assistance, please contact Hickory Learning Group at (828) 222-3749 or email info@hickorylearninggroup.org.

We appreciate the opportunity to partner with you in providing high-quality, family-centered care.