Caregiver Consultations

  • Caregiver Consultations

    Through The Boston Ability Center
  • Child's Date of Birth*
     - -
  • I am interested in a parent consultation with:*
  • My child*
  • My child*
  • My child*
  • Primary Insurance Provider*

  • Thank you for your interest in parent consultation services! Based on the information that you provided, parent consults would be self-pay. 30-minute consultation sessions will be $110 and 45-minute consultation sessions will be $165. 

  • Thank you for your interest in parent consultation services! Based on the information that you provided, we anticipate that your insurance plan will cover parent consultation services in the same way as in-clinic therapy services. You will still be responsible for copays, deductibles, and coinsurance amounts as outlined by your plan. 

  • BIRTH AND MEDICAL INFORMATION

  • Please select any assistive devices that your child uses (if applicable)*

  • RELATED SERVICES AND PROVIDERS

  • Does your child receive any of the following supports at school?*

  • Browse Files
    Cancelof

  • SCHOOL INFORMATION

  • SOCIAL EMOTIONAL OBSERVATIONS

  • Do you have any concerns surrounding your child's social/emotional development or executive functioning?*
  • What concerns do you have regarding your child’s social-emotional development? Please check all that apply:*

  • How often do self-regulation challenges occur?*
  • When upset, how long does it take for your child to calm?*
  • What do self-regulation challenges look like for your child? Please check all that apply:*

  • FEEDING OBSERVATIONS

  • Do you have any concerns surrounding your child's feeding?*
  • GI: (please check all that apply)*
  • Respiratory: (please check all that apply)*
  • Behaviors observed during feeding: (please check all that apply)*
  • Please check the methods of consumption your child has used/currently using:*
  • Please check the methods of consumption your child has used/currently using:*
  • Check All That Apply*

  • Boston Ability Center Scheduling Policies

    Please initial each of the items below to indicate understanding of our cancellation and missed session policies for parent consultation sessions.

  • Thank you for choosing the Boston Ability Center. We are so excited to get to know you and your child!

     

    I understand and agree to adhere to the appointment policy.

  • Date*
     - -

  • Additional information

  • Thank you for your interest in parent consultation sessions through the Boston Ability Center! Please press the button below to submit this form and a member of our team will be in touch shortly to discuss further.

  • Should be Empty: