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New Patient Services Request Form


Patient Information





Patient's Date of Birth:

Patient's Gender:







Patient County:




Primary Contact Information

Contact First Name:*

Contact Last Name:*

Relationship to Patient:*

*

*

Secondary Phone Number:

Preferred Method of Contact:*

EMAIL: receive a link to complete the online intake form.
PHONE: receive a call back from a member of our team.

Preferred time of contact:*

Primary Insurance Carrier:*


Reason for Appointment

Please detail your needs, concerns and medical history so as to best inform our Care Coordinators in scheduling your appointment and pairing you with the most appropriate clinician...




Miscellaneous

Do you want to be on our newsletter mailing list?






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Check Your Insurance Coverage

NeurAbilities is an “in-network” provider with the following insurance carriers:

  • Amerihealth PPO
  • Amerihealth HMO
  • Amerihealth Administrators
  • Independence Administrators
  • Independence Blue Cross (IBC)
  • Horizon Blue Cross Blue Shield of NJ (no medicaid coverage)
  • Qualcare
  • Keystone Health Plan East
  • Empire Blue Cross Blue Shield
  • Highmark Blue Cross Blue Shield
  • Capital Blue Cross Blue Shield
  • Personal Choice
  • Multiplan
  • Opt-Out Medicare
  • Magellan Behavioral Health of PA
NeurAbilities Healthcare is the premier provider of neurological and neurodevelopmental services in New Jersey and Pennsylvania, offering comfort, hope and answers that transform the lives of individuals of all ages, and their families.

Our Mission

To transform the lives of neurodiverse individuals through precision medicine, behavior sciences, and therapeutic treatments with compassion, dignity and respect.

Our Vision

To be the leading provider of comprehensive and coordinated neurological, behavioral, and therapeutic services.

P: 856 346 0005 F: 855 266 6180

© NeurAbilities Healthcare

Our Core Values

  • Compassion
  • Collaboration
  • Integrity
  • Excellence
  • Joy
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Notice of Privacy Practices

NOTICE: This website is for informational purposes only and is not intended as medical advice or as a substitute for a patient/physician relationship.