Client Forms - Treehouse Therapy CenterTreehouse Therapy Center

Getting Started with Treehouse Therapy

Before your first appointment, please complete the appropriate forms below. This information helps our Board Certified Behavior Analysts (BCBAs) create the most effective, individualized treatment plan for your child.

Important Information

Please allow 30-45 minutes to complete all forms. You can save your progress and return later if needed. All information is kept strictly confidential in accordance with HIPAA regulations.

📋 Required Documents & Forms

Please download, complete, and bring these important documents to your first appointment

EIDBI Autism Brochure

Learn about Early Intensive Developmental and Behavioral Intervention services

Download PDF

Provider Responsibilities

Understanding our EIDBI provider agency responsibilities and commitments

Download PDF

Rights & Responsibilities

Your rights and responsibilities as an EIDBI service recipient

Download PDF

Privacy Practices

Notice of Privacy Practices - HIPAA compliance information

Download PDF

Appeal Rights

Information about your appeal rights and grievance procedures

Download PDF

How to Complete Your Forms

1 Download all required documents above
2 Complete the intake forms below online or print and fill by hand
3 Bring all completed forms to your first appointment
4 Questions? Call us at (555) 123-4567

Required Forms for All New Clients

Child Information & Medical History

Comprehensive information about your child's background, development, and medical history.

Start Form

Insurance & Authorization

Insurance information and authorization for treatment and billing.

Start Form

Behavioral Assessment

Current behaviors, challenges, and strengths to help design your child's treatment plan.

Start Form

Treatment Goals & Consent

Your goals for therapy and consent for treatment procedures.

Start Form

Additional Resources

Emergency Contacts

Update emergency contact information

Update Form

Previous Records

Upload previous therapy or medical records

Upload Records

Family Information

Additional family and household details

Complete Form

Need Help with Forms?

Our team is here to help you complete these forms. If you have questions or need assistance, please don't hesitate to contact us.

Call (612) 309-4135 Send Message

Child Information & Medical History

Please provide detailed information about your child to help us create the most effective treatment plan.

Child Information

Child's First Name *

Child's Last Name *

Date of Birth *

Gender

Address *

City *

State *

Parent/Guardian Information

Parent/Guardian 1 Name *

Relationship to Child *

Phone Number *

Email Address *

Diagnosis & Background

Primary Diagnosis *

Date of Diagnosis

Diagnosing Professional

Previous ABA or Therapy Services

Medical History

Current Medications

Allergies or Medical Conditions

Emergency Medical Procedures

Current Challenges & Concerns

Primary Concerns *

Check all that apply to your child:

Communication difficulties Social skills challenges Repetitive behaviors Tantrums or meltdowns Difficulty with transitions Self-care skills Sleep difficulties Aggressive behaviors

Treatment Goals

What are your goals for ABA therapy? *

Additional Information

By submitting this form, you consent to Treehouse Therapy Center collecting and processing this information for treatment purposes in accordance with HIPAA regulations.