Authorization for applied behavior analysis (ABA) therapy services for a minor, covering treatment methodology, data collection, parent training requirements, and insurance authorization. Parent/guardian signer.
The ABA Therapy Authorization & Parent Participation is a ready-to-use healthcare & wellness template you can send for signature in minutes. It is written for 1 signer (parent) and, by default, expires 30 days after it is sent if left unsigned. It covers consent, healthcare, aba therapy, behavioral health, pediatric, autism. Like every Abundera Sign template it is a convenience draft structured for ESIGN Act and UETA compliance, not a substitute for legal advice. Each signed copy is sealed with PAdES-LTA digital signatures, dual RFC 3161 timestamps, and a tamper-evident evidence package in WORM storage.
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# ABA Therapy Authorization & Parent Participation > **Important — not medical advice.** For use by a licensed provider; verify state scope-of-practice and informed-consent rules. **Date:** ___________ **Agency / Provider Name:** ___________ **Supervising Board Certified Behavior Analyst (BCBA):** ___________ **BCBA Certification Number:** ___________ **State License Number (if applicable):** ___________ **Child's Name:** ___________ ("Learner") **Child's Date of Birth:** ___________ **Diagnosis / Qualifying Condition:** ___________ **Parent / Legal Guardian Name:** ___________ ("Parent/Guardian") **Relationship to Learner:** ___________ --- ## 1. Description of Services (a) Applied Behavior Analysis (ABA) therapy is an evidence-based, data-driven approach to understanding and improving behavior. ABA is recognized by the U.S. Surgeon General and the American Psychological Association as an effective treatment for Autism Spectrum Disorder (ASD) and other developmental conditions. (b) Services may include, but are not limited to: functional behavior assessment (FBA), behavior intervention plan (BIP) development, discrete trial training (DTT), natural environment teaching (NET), verbal behavior (VB) instruction, social skills training, toileting and self-care programs, reduction of interfering behaviors, parent and caregiver training, and collaboration with school and medical teams. **Service Setting:** ___________ **Anticipated Weekly Hours:** ___________ --- ## 2. Assessment and Treatment Authorization