Intake Form
Please set aside some time to complete this intake form. The goal is to get a full picture of your child in the following areas:
- Medical History
- School Information
- Parent/ Guardian / Household Information
- Strengths & Areas of Concerns
- Your Goals for Treatment
*** You will need to upload the following documents on your computer or device to fully complete the form.***
- Pictures of the the front and back of your insurance card.
- Diagnostic Letter
- IEP (if you have one)
Parent Agreement Form
This form goes over general expectations for caregivers during treatment
Consent for ABA Services
This form grants us permission to begin services and outlines your financial responsibilty.
Photo & Video Consent
Let us know if we have your permission for photography and video use in treatment and training.
Comminication Authorization
This form helps us know your communication preferences.
Home Saftey Assessment
Checklist that helps to ensure the home environment is safe, supervised, and appropriate for ABA sessions.
Coordination of Care
This form grants permission for GWU to collaboration with outside providers and professionals.
Parent Handbook
Provides families with GWU policies, expectations, and procedures for successful ABA services.