Home
About Us
Services
Educational
School Training & Consultation
Mosaic Minds Academy provides evidence-based training for school districts and individual programs within those districts such as crisis intervention and positive behavior support through the principles of ABA.
School Readiness Program
Mosaic Minds Academy prepares your child for the school environment through social interaction, structure, and basic learning skills.
Developmental
Screening Program
Mosaic Minds Academy offers an array of comprehensive screening options to promote early identification of communication, early learning, feeding, and motor development concerns.
Food Exposure and Toleration Therapy
Mosaic Minds Academy creates an environment that fosters safety and confidence within your child and encourages them to explore, experiment, and improve their comfort with and around food.
Music Therapy
Mosaic Minds Academy uses music therapeutically to address behavioral, social, psychological, communicative, physical, sensory-motor, and/or cognitive functioning.
Speech Therapy
Mosaic Minds Academy focuses on various communication needs presented in your child from early infancy to early adulthood.
Occupational Therapy
Mosaic Minds Academy helps improve your child's ability to participate in their daily occupation such as activities that they like to do and need to do!
Social-relational
Social Skills Therapy
Mosaic Minds Academy supports learners with cognitive skill gaps in which your child may misread social cues, struggle to infer the unwritten social rules, or hard time making and keeping friends.
Behavioral
ABA Therapy
Mosaic Minds Academy helps address a variety of affected developmental domains, such as cognitive, communicative, social, emotional, and adaptive functioning while reducing problem behaviors.
Resources
Contact
Enroll Now
In Crisis?
Client's First Name
Client's Last Name
Client's Birth Date
Client's Gender
Client's Language Spoken (Primary)
Client's Language Spoken (Secondary)
Client's Address
Client's City
Client's State
Client's Zip code
School/Daycare Name (If Applicable)
School/Daycare Address (If Applicable)
School/Daycare Hours (If Applicable)
I. Client Information:
1 / 6
Parent/Guardian First Name
Parent/Guardian Last Name
Parent/Guardian Street Address (If Different From Client)
Parent/Guardian City
Parent/Guardian State
Parent/Guardian Zip Code
Parent/Guardian Email
Parent/Guardian Phone
II. Parent/Guardian Information
2 / 6
Primary Insurance
Insurance ID
Name of policy holder/Insured
Relationship to client
Policy holder DOB
Street Address of Policy Holder (If Different From Client)
Policy Holder City
Policy Holder State
Policy Holder Zip Code
Primary Insurance Card
Primary Insurance Card Front Side
Primary Insurance Card Back Side
Secondary Insurance Card (if applicable)
Secondary Insurance Card Front Side
Secondary Insurance Card Back Side
III. Insurance Information:
3 / 6
Reason for Referral
List your child's Diagnosis
Who provided the diagnosis?
Date of diagnosis
Hours available for services
Pediatrician name and phone number
How did you hear about Mosaic Minds Academy?
Is there any other information that you would like to share?
IV. General Information
4 / 6
Speech Therapy
Occupational Therapy
Applied Behavior Analysis (ABA)
Social Skills Therapy
Development Therapy
Feeding Consultation
V. Services Requested:
5 / 6
First Name
Last Name
Relationship to Client
Phone
V
I
. Emergency Contact Information: (Other than parent listed above)
6 / 6
Previous
Next step
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.
