ABA CONSENT FORM AND AGREEMENT TO EVALUATION

• Services will focus on the development and implementation of a functional behavior assessment and an ABA treatment plan. ABA services will be provided by a Board Certified Behavior Analyst (BCBA), Board Certified Assistant Behavior Analyst (BCaBA) or a highly trained Behavior Specialist under the supervision of a BCBA.

• We, at Behavioral Fluency provide services based on the individualized needs of our clients.

• Behavioral assessment results and a preliminary treatment plan are available to the client and parent/guardian upon completion.

• The contents of both the assessment and treatment plan will be explained to the client and/or family,and staff will willingly answer any related questions about the assessment or proposed service. We understand that this information is confidential, and will abide by established confidentiality policies and procedures.

• In addition to ABA treatment, ABA services also include training and ongoing consultation in the principles of applied behavior analysis as they pertain to the client’s treatment plan with family, educators, and any related service providers.

Your signature below indicates that you have received and read the information in this document. Consent by all parents/legal guardians is required prior to an ABA evaluation.

I hereby agree and give my consent for Behavioral Fluency to evaluate my child: