Autism Treatment Request Form

Submit authorization requests for initial or updated treatment plans for Autism services.

  • Download the Autism Treatment Request Form to submit authorization requests for Autism Services. Fax completed forms to 717-851-1414 Attn: Care Management or mail to:

    Quest Behavioral Health
    Attn: Care Management
    PO Box 1032
    York PA 17405

    A Quest Care Manager will review the request and provide a determination. Please contact Quest at 800-364-6352 or 717-851-1480 with any questions.