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BIAC Provider Registry FormThe Brain Injury Association of Connecticut (BIAC) is an independent non-profit organization dedicated to supporting individuals with brain injury, their families, and caregivers while increasing the community's understanding of brain injury and its prevention. To achieve this mission, we operate a toll free Information & Referral line that is staffed by community advocates to respond to the varying needs of our callers. We provide contact information but do not endorse or refer to specific providers. We often receive calls from individuals requesting provider contact information for services that are offered via the Acquired Brain Injury (ABI) Waiver. We also receive calls from survivors who do not qualify for the Waiver but would like to pay for services with other insurance or private pay. We maintain our own resource listing of independent providers and provider agencies. To that end, we are contacting you to inquire as to whether or not you would like us to maintain your contact information at BIAC. Please note that BIAC is not the same organization as Allied. If your answer is "yes" then please click button below to download/print form and Fax it to (860) 721-9008, email it to Carrie Kramer at: ckramer@biact.org or mail to the BIAC offices. We do not maintain any documentation on the connections we make, so please do not request that information from us. Moreover, BIAC invites you to become a professional member of our organization and/or become part of our Provider's Council. If you are interested in finding out more about BIAC membership, please check this off on the form and membership information will be sent to you directly. BIAC Membership is not a requirement to be listed in our Registry and there is no fee to be listed.
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