Consent for Treatment

Two consent forms are used at intake and at the start of clinic-based services. Both are signed by the parent or legal guardian before any treatment is delivered, and copies are filed in the recipient’s clinical record. Granting consent is entirely voluntary and may be withdrawn at any time without penalty.

The Client / Guardian Consent for Services is the comprehensive intake packet. It opens with a client information section (household members, pets, preferred contact method, prior behavior analysis services, schooling, and toileting) that families complete to the best of their ability, with intake personnel available to help. It then walks the caregiver through eighteen acknowledgements (voluntary admission, consent and withdrawal, insurance and payment, parental involvement, HIPAA, crisis management, individual rights, overlapping services, updated information, liability, abuse reporting, medical conditions and medications, attendance, transportation, timely pick-up, authorized pick-up, video recording, and the Grievance Procedure), an initialed list of Parent Responsibilities, and a set of explicit Yes / No consents covering release of information, assessment and treatment, provider supervision, photo and video media authorization, and use of electronic signature.

The Consent to Implement ABA Treatment in Clinic is the location-specific consent acknowledging that treatment will be delivered at the clinic center. It is signed by the client or guardian and the provider representative when a recipient transitions to, or adds, clinic-based services.

Both forms are on the right. Fill them in the browser at intake or download blank copies to walk through during an in-person signing.