Forms & Policies

This page is divided into three sections. Please utilize the first section to carefully review our policies and procedures. The second section contains the various forms that will need to be completed for treatment. If you are a new client, please begin with the 'Enrollment Form'. The final section is for your reference.

Information & Policies

Below, please find a comprehensive listing of our current policies and procedures. After reviewing each document carefully, please make sure to submit the ‘Policy Consent Form’ found in the subsequent section.

ABA Policies & Procedures
ABA Cancellation Policy
Coordination of Care Policy
Arival and Departure Policy
Limit of Expertise Notice
Parent's Guide to ABA Therapy
Frequently Asked Questions
Payment Policy
Discharge & Transition Policy
Rules and Regulations
HIPAA Notice

Forms to be submitted

For your convenience, the following forms can be completed and submitted through our HIPAA compliant form service.

Policy Consent Form
Enrollment Form
ABA Services Consent Form
Service Agreement
Release for Media
Group Participation Form
Permission for Electronic Transfer of Information
Authorization to Bill for Services
Allergy Form
Drop Off/Pick Up Authorization Form
Emergency Medical Authorization
Parent Participation Form
Patient Confidentiality Contact Form
Special Family Consideration
Medical History Assessment

Helpful Forms

Autism180 staff member will walk you through filling out these forms during an in-person meeting. We’ve made them available here for you to review and/or print beforehand, if you wish.

Referral Diagnosis Evaluation Form
Credit Card Authorization Form
Medical Information Release Form