Access Family Services

Application for ABA Services

    Date of Survey: (required)


    Select Your Preferred Location (required)




    Services Received:

    Intensive In HomeFamily Centered TreatmentOutpatientFoster CareSchool-Based TherapyDay TreatmentABA ServicesMedication Management


    Please rate our services below using the following scale. 1-Agree, 2-Neutral, 3-Disagree:

    My/My child’s symptoms have improved as a result of treatment received (required)

    1 - Agree2 - Neutral3 - Disagree


    Staff treated me/my family with respect for my cultural and personal preferences (required)

    1 - Agree2 - Neutral3 - Disagree


    I would recommend AFS to a friend who needed services (required)

    1 - Agree2 - Neutral3 - Disagree


    If you are neutral or disagree with any of the statements, we would appreciate hearing your concerns or suggestions for improvement in the space below: (required)




    If you would like for our agency to contact you to discuss these concerns, please indicate this and provide us with a contact number:


    HIPAA Compliance

    As a client of Access Family Services, a record of health information is made. In adhering to our Best Practices for HIPAA Compliance, we have made our HIPAA, Confidentiality & Privacy Practices document available for download.

    HIPAA, Confidentiality & Privacy Practices
    [Download]

    Client Rights Handbook

    As a service to Access Family Services clients,, we have made our Client Rights Handbook available for download.

    Client Rights Handbook
    [Download]

     

    Client Rights Handbook
    (En Español)
    [Download]