Description
Intake form, consents, release of information, telehealth and photo consent, financial policy, and cancellation agreement.
What’s inside
- Section 1: Client information
- Section 2: Parent / guardian information
- Section 3: Insurance
- Section 4: Diagnosis and health history
- Section 5: Your priorities
- Section 6: Availability
- Section 7: Consent for assessment and treatment
- Section 8: Acknowledgment of Notice of Privacy Practices
Format: Microsoft Word document (.docx), fully editable. Works in Word and Google Docs. Instant download after purchase.
Created by Charity Floyd, M.S., BCBA, for ABA business owners. Bracketed fields make it easy to add your company details.
This is a template. Customize it for your company, and confirm it meets your state laws and payer requirements. Have legal documents reviewed by an attorney. Not legal, billing, or HIPAA compliance advice.
Want every template? Get all 18 in the ABA Startup Toolkit and save, or get them free with the Starting Your ABA Company course.
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