Policy Regarding Aggressive Behavior
Our company has a zero tolerance policy for aggressive behavior. We cannot allow our therapists to be bitten, hit, or pushed during therapy services. We work with parents to assist in managing mild behavior issues but are not behavior specialists. It poses a risk to our therapists (who are mostly female) along to other patients that we serve in our clinic. If your child has demonstrated aggression in the past, as a parent/guardian it is your responsibility to:1) Let us know there has been a history of aggression 2) Identify potential triggers for aggression 3) Be physically present during all sessions and have a caregiver present that is able to physically manage child if an aggressive act were to take place. We want all services to be provided safely for both our patients and our staff. Teletherapy may be an option for some patients who pose a safety risk for themselves, staff, or other patients in our facilities. Thank you for your cooperation.
Name
*
First Name
Last Name
Has your child ever demonstrated aggression to you or another adult?
*
Yes
No
Unsure
If yes, please list type of aggression demonstrated and potential triggers
*
Electronic signature:
*
Date of signature:
*
-
Month
-
Day
Year
Date
Submit
Should be Empty: