Downloadable Forms

PLEASE NOTE: All necessary forms must be submitted prior to first scheduled session. Please submit completed forms to Mikaela Bercow, our quality assurance manager, at If you have any additional questions regarding form submission or ABA services, please contact Mikaela. 

Intake Packet for Beacon (CA)

Intake Packet for Private Insurance (CA)

Intake Packet for Private Insurance (OR)

Schedule Contract (Beacon)

Schedule Contract (Private Insurance)


Release of Information

In-Clinic Liability Waiver

Bathroom Liability Waiver

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Telf: (805) 230-3701

Fax: (805) 823-4462